Angst

Dr. Harris Stratyner, Ph.D., vice president of Caron Treatment Center and clinical director of the New York region, is internationally known for developing and implementing the groundbreaking clinical model of "Carefrontation," a treatment approach that doesn't shame or blame the patient. It recognizes addiction as a disease and stresses each individual's responsibility to work with healthcare providers to reach the goal of complete abstinence.

The holiday season is a time to eat, drink and be merry. But for many adults, it’s also a time to behave irresponsibly, according to a recent survey conducted by Caron Treatment Centers.

The survey offers some alarming information about adults’ (age 21+) behavior and attitudes during the holidays. For example:

20 percentof parents who were surveyed admitted to blacking out after returning home from a holiday party with children in the house.

Roughly 33 percent of adults admitted to leaving a party and driving after they had consumed alcohol.

Even more alarming was an outcome that revealed that approximately two in five adults who were 65 years of age and older, admitted to drinking and driving.

Fifty percentof those surveyed had seen someone leave a party after clearly consuming too much alcohol and get behind the wheel

Approximately 33 percent of adults were ok with their 18 to 20 year old children having one alcoholic beverage at a holiday party at home as long as the kids were not driving.

That covers the behavior after the party, but the behavior during was just as bad. Those who attend parties have witnessed someone under the influence at a party:

Arguing with others (68 percent)

Using excessive profanity (59 percent)

Flirting inappropriately (57 percent)

Becoming physically aggressive (56 percent)

Engaging in sexual activity (33 percent)

Posting inappropriate comments or photos on social media (19 percent)

Of adults who have ever behaved inappropriately when drinking too much at a party, 69 percent were hung over and 36 percent reported feeling embarrassed about their behavior. But fewer than one in five (17 percent) said they were concerned about their behavior.

It is never a good idea to drink and drive - indeed it is a potentially deadly idea!

As far as those who are under 21, it is illegal to drink and parents should be clear and not give mixed messages.

Alcohol is a central nervous system depressant; however, when one initially consumes alcohol it disinhibits their mood - it is therefore no surprise that individuals argue, use profanity, flirt, become physically aggressive, act out sexually or post inappropriate messages or pictures.

To this clinician, it seems rather stupid to imbibe if you are not alcoholic unless you have taken precautions - such as arranged for a designated driver. Even then one should drink moderately so they don't embarrass themselves or others. Of course a person with Alcohol Use Disorder should not be drinking at all, and again anyone under the age of 21 also should not be drinking. Yes, I know that kids drink but parents must make it clear they will not tolerate it.

I am known for my method of "carefrontation," which subscribes to a loving, gentle approach to addiction and behaviors that are deleterious to one's well being, but caring and respect should never be confused with allowing inappropriate, dangerous behavior.

If you are going to drink make sure you don't do it on an empty stomach - stay away from carbonated mixers because they increase alcohol absorption rates from the stomach to the bloodstream - don't drink on medications, and certainly on illicit drugs - if you like earning a paycheck, perhaps you should stick to soft drinks at the office party.

Remember the old saying: "an ounce of prevention is worth a pound of cure."

For the complete results of the Caron Treatment Center survey, go to their website at Caron.org, and have a very happy, healthy, and safe holiday season.

"Finish each day and be done with it. You have done what you could. Some blunders and absurdities no doubt crept in; forget them as soon as you can. Tomorrow is a new day. You shall begin it serenely and with too high a spirit to be encumbered with your old nonsense."

~ Ralph Waldo Emerson

When we read quotes like Ralph Waldo Emerson's we begin to think of things like the serenity prayer, Buddhist philosophy and sayings like, "one day at a time," as well as various religious practices, such as "turn the other cheek," "there but for the grace of God go I," and passages such as, "we must learn to let go as easily as we grasp or we will find our hands full and our minds empty."

We have all heard that addiction is an insidious disease. Indeed it is, but also we must understand the philosophy and nature of our thoughts so that they can lead us in the direction that allows us to let go of the past and stay in the moment with an eye towards the future. We bear the responsibility for taking action so that we are cognizant of the insidious nature of the addictive process.

It is simply not enough to accept the fact that addiction is cunning, baffling and insidious. We must realize that we have the power to admit we are powerless and as a result achieve the goal of sobriety – not just allowing ourselves to abstain from drugs and alcohol, but understanding that to be a sober individual truly means to "do the right thing."

Life goes by faster and faster, and when it comes down to it, one must realize that all the money in the world, all the power in the world, all the fame in the world, does not really mean that much when one is facing what Eric Erickson termed "ego integrity versus despair," – the end of life when sober judgment – knowing that you were a good individual who always tried to do the right thing, not shirk responsibility, but embrace a just existence that always concerned itself with others in addition to yourself.

Because addiction is indeed in insidious does not mean that you cannot foster the ability to prevent it from consuming your life. The whole notion around the concept of the previously aforementioned sense of "powerlessness" has to do with admitting you're powerless and therefore gaining power – a very Zen concept. Whether "letting go and letting God," or "turning the other cheek," one must not give into the insidious nature of the disease of addiction, but know in their heart that there is indeed another path!

First, we must understand that "existentialism" involves a philosophy that defines the meaning of life by what people do in life and the consequences of their actions - this lays a great responsibility at the feat of humanity and causes "angst" certainly in those who are moral.

My readers know that I more than believe addiction is a brain disease, this has been proven over and over again, in numerous scientific studies. However, acting on one's disease either by taking responsibility for it or ignoring it with denial is part of the great existential dilemma.

Faced with free will, as Kierkegaard would have said, places the burden of action squarely at the feet of the addicted individual. The discipline of recovery is a choice. It involves much time and effort, and ultimately is up to the individual.

I often relate to my patients that as a doctor of psychology who specializes in co-occurring disorders, I am there to offer the tools they need to stop the active use of substances - since it is a "biopsychosocial" disease, I offer "biopsychosocial" prescriptions, but ultimately it is their choice to accept what I have to offer. This often is in the form of outpatient or inpatient treatment, and is made up of medical detox, rehab, individual and/or group psychotherapy, connection to 12-step recovery, mindfulness meditation, etc., where each step of treatment being an informed decision consisting of further and further refinements.

The patient learns about what is out there in the form of treatment, and then often with friends and family decides what is best for him or her.

The existential angst is ever present as the individual realizes that his or her decision involves commitment and effort - and regardless of support, will ultimately be their undertaking. This is particularly difficult for developing adolescents who often see getting high as much simpler.

Standing at the ledge of a tall building and knowing you can jump is where the angst comes into play - the sudden realization that we and we alone decide our destiny (as the great existential philosophers have taught through the centuries) - but we can also walk away and live another day!

One begins to see just how interwoven addiction and existentialism truly are - and the accompanying angst that goes with the clarity that we and alone, help to shape the meaning of life, which impacts all of reality. Remember as Donne, Hemingway, and even Metallica discovered: "For whom the bell tolls, it tolls for thee." In this realization we come at once to understand we decide our fate and as part of humanity, the fate of every man and woman.

A few days ago I spoke at Grand Rounds at New York Presbyterian Hospital, Weill Cornell Westchester. This particular psychiatric facility is one of the most respected in the world and rightfully so, given that they have done extensive research, and practice the scientist/practitioner model.

At this keynote session, I spoke about my model of "carefrontation," which stresses treating every psychiatric substance addicted patient with respect and dignity - not shaming or blaming the individual, but helping them to accept responsibility for their psychiatric illness and disease of addiction.

As we know many individuals suffer from co-occurring psychiatric and substance abuse issues, and with any disease must not be blamed for it but held responsible for taking care of themselves.

I said many, many years ago that just as the diabetic individual is not blamed for having diabetes, they are still held responsible for treating it so that it does not overtake their life and eventually kill them - the same is true for the psychiatric substance addicted person.

Although, many folks talk about the "pure" substance abuser, I truly do not believe after 30 some odd years in this field that that individual exists. We know that addiction is a bio-psycho-social disease, and that if the clinician also includes personality issues along with major psychiatric issues such as bipolar disorder or anxiety and depression, then every active addicted individual has psychological issues just as they have biological and social issues.

The mistake in defining someone who is a psychiatric substance addicted individual is that we let the need for medication play to important a role in our definition. There are those who will need medication and perhaps those who will not, but there are still always psychological issues involved with every substance use disordered individual, and they must be considered even if they don't fit neatly under a specific disease entity.

Addiction is a brain disorder and the liver serves an important role as well - the brain is the seat of the psychological and the liver works to ensure that impurities don't destroy the brain - certainly both organs are steeped in the biological.

Now we move on to the social aspect. All of the people in the addicted individual's life are impacted by the identified patient's illness. They also impact that individual's recovery in the various roles they play - ignoring, enabling, fearing, guilting, etc.

Responsibility is the key to helping the addicted individual. If a prestigious institution such as Weill Cornell Westchester is interested in hearing about the role responsibility plays in treating the addicted individual then it is time you, the reader were as well.

Again, addiction is a complicated illness that certainly has psychiatric components to it - some more serious then others. It requires a bio-psycho-social and often spiritual approach to help the suffering individual regain his or her health, and it all begins with promoting responsibility. All I can ask is that you consider what I have spent my profession contemplating.

When you think of all of the things we hear when we turn on our car radios, or when we watch TV, or when we listen to a podcast, or perhaps just in conversation with friends and colleagues, we begin to realize how stressful life can be.

Every day we hear about violence throughout our own country and the world. Sometimes if one is in the state of post acute withdrawal from drugs and/or alcohol it is even more difficult to listen to the background noise, especially when that "noise" is so troubling. People being beheaded, the threat of deadly disease, wars throughout the world, American troops in the vicinity of danger, drug deaths, education decline, propaganda, branches of government not acting in harmony, and on and on and on!

That is why it is so important to use everything at hand to stay sober. Therapy, mindfulness meditation, twelve step meetings, building a sober network of friends, family work, good nutrition, medication if you absolutely need it for a co-occurring disorder, etc., etc.

One must build an armamentarium to neutralize the noise - not to mention the more personal stresses and strains of our daily existence.

Remember, there is a great deal of stress in life, so don't skimp on the coping tools!

With the occurrence of Ray Rice’s domestic violence, it is important that we understand this disturbing behavior.

Domestic violence is often correlated with alcohol and drug use. It can result in Post Traumatic Stress Disorder (PTSD) which often requires therapy and even medication.

Acts of domestic violence are often directed towards females, but can also be directed towards males, and can take the form of physical violence, sexual abuse, mental abuse, verbal abuse, and the use of manipulating people with extrinsic factors such as money.

Often, children who are exposed to domestic violence grow up to be intergenerational perpetrators. Abused partners are often afraid to leave their abuser, and ironically can feel a sense of loyalty towards the aggressor, but this is usually related to their sense of fear.

Given that Ray Rice is a football player, it is interesting to note that during football season domestic violence increases. This may be due to an increase in alcohol abuse, frustration over the home team losing, loss of money due to gambling on the game, and the violence inherent in the sport.

If you know of domestic violence or are the victim of it, remember there is help out there! If you need help, contact the National Domestic Abuse Hotline at 1-800-799-7233 or visit thehotline.org

This week we lost Robin Williams. He was a very complicated man -- he certainly was a comedic genius as well as theatrically gifted.

I had the pleasure of seeing Mr. Williams perform live and of meeting him several times. Although I never personally treated him, he struck me as a very caring, compassionate soul.

Through his comedy he taught us that humor can solve a great deal -- the world needs to learn that. He was well informed and quick- witted.

He never shied away from discussing his disease of addiction or his struggle with a mood disorder.

In death, as in life, Williams has afforded us the opportunity to learn that addiction and depression (or a more complicated mood disorder) are indeed diseases. They are primary, progressive, chronic and if not treated can be fatal.

While Mr. Williams’ tragic death could make the uniformed believe treatment does not work, it indeed does. Suicide is much more rare than a productive life, and Mr. Williams fought the good fight.

Don't let the lesson his life and death has afforded us be in vain. Instead, let’s focus on breaking down the stigma surrounding addiction and emotional illness, and like Mr. Williams, continue to seek treatment!

As I gaze upon the sea from my front porch, I realize just how much it reflects the human being. Yes we all know that our bodies consist of between 50 to 75 percent water, but that is not what I am talking about here.

Sometimes the sea is gentle and still, yet, other times it is rough and wild - filled with the desire to harm whatever gets in its way. All kinds of creatures are affected by the sea - small, fragile life, and enormous, giant, creatures. A particle of sand, and the churning collective ocean floor.

The sea has tides that are effected by the moon, and man has been referred to, at times, as a "lunatic." The sea is salty and people can be "salty." The sea reflects the sky, and we are so impacted by a sunny day, a cloudy day, an evening sky - the darkness.

I wonder how many people have thought about the sea over the years in the very same spot I am in now? I know my neighbor who left the earth as we know it this morning was one such man. His name was Karl and at 8:30 am this very morning, this man in his late 80's left the world - he left his sea which he loved so much, and would cast his gaze upon so often.

Karl was an easy man to be around - he was like the calm sea - not complicated but so informed - so knowledgeable about so many things. Just like the sea, he impacted every creature he touched. In his case, he could be salty, but usually in a flirtatious way with the ladies - greeting his many female admirers with "hey babe," the way one would think Gary Cooper might have done - not dirty or sexist, just fun-loving and filled with frivolity and good times.

Karl, like the sea, was a natural. He had so much to offer, but did it by just rolling in with a quiet fact or two and then rolling back out - perhaps to look at his sea.

I collect shells from the sea. These gifts are similar to the gifts that Karl would give to me - free but precious: an interesting article from the evening paper; a W.C. Fields movie he would share; a "hand-cut by Karl" cartoon that would have me rolling on the floor with laughter.

I remember the first time Karl encountered a creature that some would say "only a mother could love" - our English bulldog Gertrude. He grew to love her and she grew to love him - you see Gertrude like Karl is also like the sea - she just "is."

I suppose I could think of many folks like Karl who loved the sea, but I cannot think of all that many like Karl who were similar to the sea on a sunny, calm day.

Karl was not a man who needed to drink or be artificially intoxicated. He was naturally intoxicated with his wife Sylvia, his children, and his friends. Again, like the sea, Karl was a natural, and did not need man to muck him up - just easy and flowing - so mindful and filled with meditative simplicity, yet so wise - so wise that those who tried to fool with him were always known for their foolishness - perhaps not by many, but by Karl, and that was enough.

Karl would regale me with stories of the great storms that made the sea angry. The one he focused on the most was the storm of 1938 that took the North Atlantic coast and played with it like a cat with a mouse. Karl told me
their were winds as high as 115 mph, and sea surges over 16 feet above mean tide. His eyes grew wide as he remembered and leaned forward on the couch. Then he sat back and went right back to being, well Karl. It reminded me of the way Clark Kent would become superman, and then go right back to being the "...mild-mannered reporter."

It is nice to just be nice - that is the lesson that Karl taught this clinician. He had no demons that I knew of - no need to show off - be the big shot. He was a man who could shave in the mirror and not have to turn away in shame.

Like the sea along the rocky New England coastline, he molded himself to just fit in - and after all folks, isn't that enough? Isn't life something that can just be lived?

How many more of us would dream to be Karl - dream to be as the natural, vital sea, to be content with being?

There are many things I am attempting to say in this blog, and I will admit that perhaps my point itself is a tad convoluted, but then again, perhaps it is not. Perhaps the simple lesson that the sea and Karl teaches us, is just allow yourself to be. Don't pollute yourself with things that spoil all the naturalness.

Karl will be buried soon - well his body will - one could never bury his spirit, for like the sea, it will continue to roll on - but quiet like on a sunny day, still, gentle, but looming large. Oh, and in case you are wondering, yes he will be buried not too far from the sea - able to sense its being, but again, calm-like, pure and simple!

It seems so easy to just be present in the moment, but if it were, I probably would lose three quarters of my patients!

Just think about all the thoughts that race through individuals' minds ruminating on the past and as they say in AA "projecting into the future." It is no wonder that people become aggravated with themselves as they feel various emotions ranging from guilt to sadness, anxiety to depression, as well as "cognitive conditions," such as sobriety to self-medicating inebriation.

I have always considered myself to be a student of mindfullness. I'm fascinated by this Buddhist tradition through the gateway of meditation.

As a doctor of psychology, I utilise this practice with my patients all the time - whether through cognitive behaviour therapy to motivate individuals to focus on more productive ways to think and behave (under my model of "carefrontation"), which is similar to Kabat-Zinn's Mindfulness-Based Stress Reduction (MBSR), or Hayes' Acceptance and Commitment Therapy (ACT).

The goal is always to strive for a stress-free, sober, and "now" based existence; to achieve the full essence of every waking moment, let the past go and the future be tomorrow.

So many patients believe that if they don't use alcohol or drugs, they are sober. This simply is not the case: They may be abstinent but that does not mean they are sober!

Sobriety is about being a clear-minded, honest, decent person; one who cares about humanity, and has given up the dishonesty of "the truth only fits when a lie will not."

I like sober people. They are down to earth and in a word "real." Sober individuals do not surround themselves with pretense. Sober people have learned the arduous lesson that we are all equal: We are not separated by how much "stuff" we have acquired, or the name of a brand that Madison Avenue created to make us spend more of our hard-earned dollars so that we can falsely feel better about ourselves!

I am quite frustrated with the "gimmicky" approaches to keeping people sober. I must admit that I am biased towards education and a true understanding of knowledge that is evidenced-based and not merely "contemporary shtick"

One should not stop using drugs or alcohol so that they can pretend to be sober when they are nothing more than what has been referred to as a "dry drunk." Sobriety is a journey. As they say in the rooms, it is all about life on life's terms and not merely about stopping the ingestion of a mind- altering substance.

I am so sick of "pop psychology." If you want to get sober, do the work: stop lying, get honest with yourself and others and be a decent, caring individual who actually considers putting others before yourself. In plain English, " Get your act together."

Ok, here are the facts: Mental Illness and addiction are diseases! The reality is that, as I have said literally thousands of times, a disease is primary, progressive, chronic, and if not treated potentially fatal.

I suppose because psychiatric and substance abuse disorders make individuals act differently - perhaps unpredictably - we simply cannot accept that they are diseases and we stigmatize those who possess them.

Have you ever seen someone who is out of it from a raging fever? Certainly, they act less then what we consider normal. What about someone who is having a hypoglycemic attack, or the individual who is going through treatment for Hepatitis C with strong chemical cocktails: Ever witness their affect?

All I am saying here is that it really is time to stop attacking people with psychiatric and substance abuse illnesses. They are not moral failures. They are not weaker than the rest of us. Yes they need to struggle with taking responsibility for dealing with their illnesses, but they really are simply humans with disease entities, not an excuse but a reality!

You know as I was writing this blog, I saw a piece on television on 24 folks who were not awarded the medal of honor for their service in WWII, Korea and Vietnam because of the color of their skin or religion (in this case Jewish), so perhaps stigma comes natural to us!

As far as this doctor and more importantly human being is concerned, it is a disgusting side of our humanity, which warrants each one of us to get in touch with our hearts and souls!

It's no secret that addiction is a disease. It is primary, progressive, chronic and if not treated potentially fatal.

I know this first as a clinician with more than 37 years in the field, and second as a researcher of co-occurring disorders and psychiatric substance abuse.

These days I am very mindful that while we are hopeful about 2014, tremendous uncertainty and fear seems to lurk around the corner.

Our safety as a nation is still in question. We are a part of a global village that has to contend with terrorism, environmental erosion, the threat of nuclear proliferation, and still have worries about financial crisis.

As a moral people, we have seen our values change - a diminution, if you will, of decency and respect for others at times, with language used in the streets that is only superseded by lyrics in songs! This is not to say that we have gone to hell in a handbag, but we do need to get back to caring a tad more. As Hillary Clinton once said, "it takes a village."

It is no wonder some take that first drink or drug to self-medicate anxiety and depression! After that, the disease takes over and they are off to an addictive process that spirals down a staircase of pain and suffering biologically, psychologically and socially.

As a clinician, I'm keenly aware that human beings are always seeking to self-medicate their anxiety, depression or perhaps guilt or shame.

As the father of "carefrontation" as it applies to dually diagnosed individuals, I advocate for caring: much like a self-help program such as AA does. We need to embrace people with addiction issues and understand the process that leads to that first drink or drug - look for reasons to keep individuals in treatment and not excuses to kick them out!

Although I do not represent AA, I am aware that one can go to a meeting intoxicated and if they are not disruptive they are allowed to stay. This should be interpreted as "do no harm" of the highest calling. You can't treat an empty chair. And as long as you are willing to work with someone, there is hope that they might hear what you have to say.

Psychologists learned a long time ago that trying to scare someone into changing does not lead to permanent change, but through care and education, responsibility for one's behavior can begin to be cultivated in the person's mind and real change can develop.

We can then, and only then, be assured that challenging times won't increase the chances that someone will act on his or her disease.

What you are about to read is my offering for the new year. It is my reason why no mind-altering chemicals need to be taken, and for that matter why they should be avoided.

Why? Because mind-altering substances clutter what Sigmund Freud would have called our unconscious and Carl Jung would have called our collective unconscious. For my part, I like to call it our "singular and collective conscious," with all due respect to Drs. Freud and Jung.

Science has shown that caring helps us to survive. It is indeed hard-wired.
The vagus nerve which is made up of a bundle of nerves that goes from the head of your spinal cord and innervates the heart, liver, lungs and organs of digestion, literally is key to our feeling warmth and goodness -- that lump in our throat and burgeoning sense that we are moved to tears.

Indeed, it may have a connection to that neurotransmitter that triggers maternal bonding, oxytocin.

Science and God -- nature, humanity, spirituality, are indeed connected. Call it whatever you want based on your belief system. This is not "hocus pocus." This is based on quantum physics: We know that consciousness is linked. Every action affects every other action.

Let me end on this note, which may come off as a loose association, but ties it all together for this psychologist.

The element Argon (which does not react with anything else) can be traced in every breath of air we take and can be connected over the centuries. So theoretically, the air you breathe in and out may have been breathed by Dr. King, W.C. Fields, Washington, or even Socrates.

Yes folks, we are all connected. We all have the capacity to feel for everyone else and we are one, and life is one, and love is one. So love your life and don't trample on it because it is you!

Often, my patients, be they young or old, want to know how I come up with some of my perspectives on their lives. It's really quite simple: They tell me!

You see, I know about my patients' families and friends and their interactions from what they tell me. They discuss their boss or an employee, a husband, wife, son or daughter,and since I often have not met these individuals, I must base my understanding on what my patients believe about them.

Now let me be clear: My patients are sharing their views, which does not mean they are correct, but that is what I have to go on.

It is, indeed, my patients' opinions that count. It is their lives and interactions we are dealing with. Sometimes I am lucky enough to get collateral information from others and directly formulate my own opinions. Usually, however, these meetings are few and far between and many times my patients are reluctant for them to occur.

Admittedly, I may be able to deduce patterns across relationships, but ultimately I must utilize the canvass my patients create to draw my interpretations.

Perhaps this is why psychology is both a science and an art. I am a trained professional who has a certain armamentarium at my disposal to ascertain what is real and what is not. Particularly, I must rely on the art of being a good listener. I look for consistencies, eye contact, hesitation, body gestures, and so forth.

Additionally, I must ascertain how a patient literally sees things, hears things; this truly involves their eyes and ears. Psychologists spend a great deal of time studying the senses. It goes without saying that the senses inform the brain of what is occurring. Also, are their cognitive processes in tact? Are they accurate or do they go off on thoughts that are tainted by their past, colored by their respective anxieties, preoccupations, fantasies, delusions -- perhaps by the use by the use of alcohol or drugs?

Therapy is a very complicated matter. I just thought that you, the reader, might like to consider that a therapist is only as helpful as the information we are provided!

I believe that doctors of psychology have an obligation to help inform the public about how it works; to demystify psychology and as many counseling psychologists say, to give psychology away!

People spend their lives in school studying the intricate procedures in conducting research, as I did. And yet when studies on a drug like marijuana are conducted and clearly demonstrate that chronic marijuana use beginning at a young age can lower your IQ and lead to various forms of cognitive dysfunction, kids and many parents choose to ignore the results!

A study discussed in "Psychology Today" (2012) did a longitudinal review with youngsters beginning at the age of 13, and going up to the age of 38. The study utilized a battery of tests, including IQ measures, which revealed that a significant number of subjects lost as many as 8 IQ points related to chronic cannabis use.

Many subsequent studies have demonstrated the deleterious effects of tetrahydrocannabinol (THC) on the brain --- particularly the frontal lobe, which impacts focus and attention, even in later years (Gruber, 2010).

Young teens with increased risk for disorders such as schizophrenia and schizoaffective disorder are at greater risk of developing these disorders earlier (Sevy, 2010).

So, here is my question: If you have taken the time to read this blog, are you going to play Russian roulette with your young brain? Parents are you going to continue to view marijuana as harmless?

As the trees shed leaves, the sky gets dark earlier and in certain parts of the country the weather turns cold, some of us feel a sense of angst!

Of course, we have heard of Seasonal Affective Disorder and know there are those who truly get depressed, but I actually am not talking about the "clinical" here. Rather, I'm talking about the human sensation of a feeling of loss.

As the winter approaches our lives become more difficult: We are locked into our "cabins" for the heat, find the sky looking bleak and busy. Again, in some areas, we are forced to get snow tires and contend with the burden of shoveling snow, rising fuel costs, and the seasonal holidays that actually were meant to brighten our spirits, but depress us because of their financial burdens.

However, there are turkeys and dressing and sweet potato pies, mince meat, pecan and pumpkin confections, parades, gifts; and good cheer. But somehow when our finances are low our worries are high!

My only words of wisdom are make the most out of what you have, and remember why you are truly thankful!

There are many psychiatrists, psychologists, etc., who work every day to make their patients feel better - at least that is their goal.

The work we do is very intense; think about it. You have individuals with PTSD and other anxiety conditions, addictions, personality issues, mood disorders, eating disorders, reality testing issues, anger management issues, sexual identity issues,family, relationship and vocational issues, etc., etc.,

Many of these issues can be directly traced to the ego or disturbances revolving around self-esteem and self-efficacy. There are those folks who feel less than everyone they interact with, people who don't believe in there ability to accomplish a task, individuals who use primitive defense mechanisms which result in others becoming extremely frustrated and angry with them - and the list goes on and on!

I am sure I don't have to remind anyone that therapists are people, too. We have good days and bad days - something as simple as a traffic jam can frustrate anyone - perhaps an argument with our spouse, or even something as trivial as our favorite sports team losing a game, can place us in a mood that would be less then conducive to helping our patients work through their respective issues. Thus, a professional therapist, doctor, counselor, clinician, must constantly stay "in the zone."

This requires that the professional receive supervision, be in their own treatment, take care of their nutrition, exercise, and sleep requirements, or all of the above and then some.

As a practitioner for some 36 odd years, I don't see this happening as much these days. The economic zeitgeist is such that supervision and therapy are expensive and time consuming - and clearly their absence leads to deleterious effects on the counselor's well-being - just what we would tell our patients!

Therapists can simply not allow this to happen - I cannot stress this enough! Where there is a will there is a way.

Put together peer supervision groups, read journal articles on supervisory issues, sit quietly for 15 minutes a day and meditate, go for a twenty minute walk, eat three healthy meals a day and healthy snacks, drink plenty of water, cut down on caffeine, leave for work fifteen minutes earlier to avoid traffic, if appropriate, attend a twelve-step meeting.Look at these healthy, centering practices as necessities rather than options. We owe these healthy choices to ourselves and to our patients!

For many years, Jon Kabat-Zinn has accomplished the art of mindfulness through vehicles such as meditation and yoga, etc., to reduce stress and depression, as well as other psychological and physiological issues. Thus, he contributes to the field of psychology immeasurably.

I have always been interested in utilizing mindfulness to "center" individuals. Indeed, my therapeutic technique of "carefrontation" focuses on engaging patients with caring, respectful but honest dialogue to make them aware of their internal process: striving to "rebuild" the ego in a manner that is syntonic and takes the fear out of thoughts. In so engaging in such a process one's thinking is redesigned, resulting in the individual taking on responsible actions (e.g., getting sober).

As a human being, I believe I must practice being mindful; what I like to refer to as "minding my mind." To my knowledge, human beings are the only animals that can study the mind with the mind, and if they practice they can do it spontaneously within the moment.

Many proponents of mindfulness propose allowing our thoughts to "wash" through ourminds - aware of them but not "stuck" on them. Of course, as we practice this, we must be cognizant that time is passing and progressing - that all we truly have is the moment!

Many 12-step programs stress the importance of staying in the moment. These programs appear to understand that all we have is now - but if we are aware of the "now" we can make the most of it. The secret ingredient seems to be that if the essence of the moment is our focus, then we begin to understand that our thoughts are passing. Therefore, awareness of our thoughts allows us to better "judge" their validity. We can thus rule out those that lead to aimless worry while embracing those that bring us peace and constructive lives.

To this day, I always have a sense of angst when an individual who is destroying his or her life with drugs, alcohol, or some form of process addiction (such as gambling), is so filled with denial.

Whether one considers it the "precontemplation stage" of motivational theory (see Prochaska) or simply one of myriad defense mechanisms, it is still interesting to ponder the palpable reluctance about reality.

As a doctor of psychology, it fascinates me that people who are paying you for help, will look you straight in the eye and lie: Is it a conscious process or unconscious? Even if it is conscious, there is still an aspect to denial that stems from the unconscious because the individual is not in touch with the internal conflict that drives their intent.

Shame seems to be a major culprit in this insidious block to engage in honesty (the shame of genuine engagement in the therapeutic process being replaced with activities that are so deleterious to one's well-being).

I must admit, in terms of my own internal mechanism, as I get entangled in counter-transference, I question if I have done something wrong (probably stems back to my childhood). Of course, as I emerge from my own "narcissistic journey," I inevitably return to the reality that it is the patient attempting to be seen in the best light -- even at the cost of his or her treatment progressing in a positive direction.

I will let you in on a little secret: Therapy takes at least two people in the room. If the therapist is working harder than the patient, something is not working. I first noticed this about 25 years ago, when I began to develop my conceptual framework for "carefrontation." This therapeutic approach is rooted in a process that at once attempts to arrive at the truth without raising a patient's defense mechanisms; easier said then done!

Simply attempting to have a genuine discussion, as Carl Roger's would have said, should in and of itself, create a fertile ground for the patient to put an end to their reluctance to be honest.

I have always found it easier to be open with my patients, and set an example of honesty. You will never hear me say, "We are here to talk about you not me." Instead I will model, to borrow a Bandurian term, for the patient the importance of being honest, and then gently put the focus back on him or her.

In a time when insurance companies and the social zeitgeist in general places a high emphasis on a "speedy recovery," I find there is not a great deal of time for confrontation, which ironically tends to increase defensiveness. I want to make it clear to my patients that we are a therapeutic dyad with a common goal: simply stated, recovery.

I love being a psychologist. I will admit, it can be frustrating at times. I strive to motivate my patients to be less reluctant about reality, utilizing consciousness raising to instill understanding the primary, progressive, chronic, and if left untreated, perhaps fatal result of their disease of addiction.

It is important to underscore that a disease should be thought of as a "dis-ease," or a feeling of being uncomfortable. Proceed gently but firmly, fairly and honestly, patiently but with direction, to get the individual to take ownership, responsibility, and solace as they strive to recover and maintain recovery. Anything short of this process, in this clinician's humble opinion, is a waste of time!

I don't think the term is derogatory. I know many of my colleagues do. We're all entitled to do our own thing.

As someone who has been practicing in the very serious field of psychology for more than 35 years, however, I believe I've earned the right to make light of myself.

"Shrink" is a slang term referring to a psychologist or psychiatrist who "shrinks your head," alluding to a touch of sharmanism or even voodoo. The irony is that psychology is actually about expanding a patient's mind to myriad possibilities that await.

Perhaps the term "shrink" sounds more hip among urban hipsters (hey wait, does that mean I am an urban hipster? Not.) who see their therapist as a "luxury." In many cities like the one where I work (Manhattan), it almost seems like having a "shrink" is a way of life.

Make no mistake about it, seeing a doctor of psychology or psychiatry is not like seeing a barber or a stylist: Rather, it's about examining one's life in the name of understanding (which hopefully leads to a fuller experience), at least for the "worried well." For those with more serious forms of mental illness, it helps them deal with pain and anguish.

Socrates once said: "The unexamined life is not worth living."

So long as the tour guide for the examination is qualified, I don't really care what he or she is called ("a rose by any other name would smell as sweet").

I''m exercising my sense of humor when I call myself a shrink, And, said William James, the father of American psychology: "Common sense and a sense of humor are the same thing, moving at different speeds. A sense of humor is just common sense, dancing."

Perhaps if one thinks of a "shrink" as a term of endearment, it becomes more palatable: Hey I've got it, we "shrink away your worries."

Really, what's in a title. Focus on the process, not the name your therapeutic partner uses, and you will be fine.

As someone who played baseball in his youth, that Great American Pastime, I always believed if I pitched a good game or hit a home run, it spoke to who I was as a player.

I am sure that if I resorted to taking performance enhancing drugs, I would have personally felt like the drugs were responsible for my success and certainly not me. So why don't so many of today's Major League players feel this way?

In 2011, Ryan Braun, the MVP for the National League, was suspended for using PED's for the remainder of the season without pay. Bud Selig, the commissioner of Major League Baseball, spoke of the allegations that Braun was utilizing the Biogenesis clinic of Florida to acquire these drugs. And now we see deja vu all over again with AROD - Alex Rodriguez - one of the star hitters for the New York Yankees.

Phenomenal money is involved with AROD's suspension. And hile this is important to AROD, no doubt, this doctor is more concerned with the message we are sending to our youth

Baseball, like all sports, is about how we push ourselves; what youngsters can do when they train and focus on a sport they love. Granted, many players have juiced, and perhaps AROD and others felt they had to keep the playing field "even." However, we know that more players have chosen not to use PED's and have stayed true to the game, providing wonderful role models to millions of youngsters.

By taking anabolic steroids athletes grow bigger muscles, and may recover from hard workouts faster, They pay a high price, however.

Many of these athletes take a combination of natural hormones like testosterone and synthetics, at high dosages, basically putting their bones at risk of breaking more easily, enlarging their hearts, increasing their blood pressure, elevating their cholesterol and triglycerides -- all of which are causes of heart attacks and strokes.

Kidney disease is also prevalent. And if you’re not as interested in living, but just want to look good, your hair is likely to fall out and you are at greater risk to develop acne - not to mention psychological damage, right up to full-blown psychosis.

Is this really a favorable result from America's favorite pastime?

Do yourself a favor: If you are a parent or grandparent, speak to your children, yet again, about the dangers of drug use. That is basically what we are talking about.

And if you should happen to be a youngster reading this blog - please note, I don't use scare tactics - the truth is scary enough.

It is inevitable, that at sometime in your experience as a parent, you will encounter your child or children, contemplating some form of experimentation with alcohol and/or drugs. How will you respond?

I am a firm believer that despite the "inevitable," a parent's responsibility must be to adopt a zero tolerance stance. It does not matter what your children end up doing; you are their parent and your position on drugs and alcohol must be firm. Otherwise, the burgeoning adolescent becomes confused.

Parents need to remember that adolescents are at a very vulnerable time in their lives: They have tremendous peer pressure, raging hormones, thoughts they are struggling to understand, and need the stability of parents; the boundary-setting adults who are loving but clear with regard to what the "rules" are for their children.

Parents who set the wrong example for their kids do a great injustice, and often have no concept of the results of their actions. Bandura's concept of "modeling" is important to be aware of: We are indeed models for our children. We are not their friends but their parents. They do not need to hear of our adolescent escapades when "we were their age." Understanding can be demonstrated without graphic details of our youth and misguided attempts to bond through trying to "brag" about "how we get it."

Youngsters don't want to hear about parents getting high! Lead by example in the here and now, not by regaling them with "war stories." Our children need us to guide them, and we need to have a strong footing. They need to know they can come to us with anything, but that we are first and foremost their parents, solid, reliable, and clear about the rules!

I have worked in some professional capacity in the field of mental health and addiction for almost 36 years (since the age of 22).

I have worked for New York State psychiatric centers, famous private psychiatric hospitals, and for the majority of my career, famous Ivy League academic institutions.

I was always the "addiction guy." More specifically, I was the specialist in co-occurring disorders. I always found it fascinating that despite the fact that addiction is a psychiatric disorder (according to the DSM 5 for example, an addiction is considered to be psychiatric in nature), yet, this honestly has never truly sat well with my addiction colleagues, nor has it sat well with my mental health friends (at least not with many).

I suppose the culprit on both sides is that wonderful word "stigma." Can we get honest for a moment - nobody likes being labeled as an "addict," and certainly being branded as "mentally ill" does not sit well with most people.

Ironically, many patients have both - especially if you add personality disorders in the equation.

Why can't we just treat people like human beings; after all, if you have diabetes, cancer, thyroid disease, high blood pressure, heart disease, psoriasis, etc., you have a disease. Does it matter if it is centered above the neck or below?

It is so disturbing to stigmatize the addicted person who struggles with a mental disorder - or for that matter the mentally ill person who struggles with an addiction, or the individual who has one or the other.

The true issue is, we as a society are frightend by "drunks," "addicts," and "crazy" people. Hey folks, these are the terms that Joe Q. Public uses: a bum, rummy, dope addict, loony, nut, junkie, head case, fruit cake, maniac, psycho, lush, etc.

Why don't we stop it already and face the fact that every human being alive today has a friend or family member that suffers with an addiction, psychiatric illness, or often both. Is that any way to talk about a loved one! Give it some thought on your way to your cardiologist, or your endocrinologist or dermatologist.

I recently had actor and screenplay writer Chazz Pominteri on my radio program, "Here's to Your Good Health," (AM1230 WFAS.com).

At one point during the hour, we discussed how folks, particularly up to the age of say 30 or so, have made communication through texting a way of life.

Just think about it. I am sure you have all been in a restaurant, and you observe a bunch of adolescents or 20-somethings with their cell phones out, texting away, instead of relating directly with people at the table.

It seems to me that we are raising the socially reluctant. It is like "Night of the Living Dead"; masses of young people who "let their fingers do the talking." No ability to use whole sentences, make eye contact, show a facial expression, or use manners such as "thank you," "please," "nice to see you," or dialogue references such as, "You don't say"; "I hear what your saying"; "tell me more ..."

"God grant me the serenity to accept the things I cannot text, the courage to change to speech, and above all, the wisdom to know the difference!"

As a doctor of psychology, married to an oral surgeon, my wife and I have certainly been able to give our daughter a great deal. Furthermore, just having one child, we have been afforded the opportunity to give her even more. However, would giving her whatever she wanted really have been prudent?

When our daughter was growing up, my wife and I instilled in her the importance of working for what you truly want. If we had just handed things over to her, I don't believe she would have developed a work ethic.

I notice in my practice, that at times parents are so willing to give their children everything -- to the point where they negate the motivation in their youngsters to have a sense of working for what it is they desire.

I have never been the type of person, or for that matter psychologist, who points his finger at others and chastises them for what they did or didn't do. Life, after all, is a journey designed to learn as we move through it. Nor do I believe that it is ever too late to change the way one proceeds.

I believe we owe it to our children to help them to help themselves to navigate through life and learn from their struggles. Life is such an exciting adventure to embark on.

I remember when I was a boy, I wanted a gas propelled model airplane. My father could have given me the money, but where was the lesson in that? Instead, he said if I was able to earn half the cost, he would match me dollar for dollar. I had a goal! I quickly lined up some neighborhood jobs: mowing lawns, dog walking, etc. By the time I had
enough for half of the plane, I was so excited and most of the excitement, I can assure you, came from the fact that I had earned the plane.

My dad had made my goal obtainable with his offer to pay for half if I earned the other half. He was wise enough to take the opportunity to turn my "dream" into a realistic goal that quickly became one of life's lessons: If you want something badly enough, you can achieve your goal through hard work.

That lesson has stayed with me right up to my current age. I am always willing to work hard, because it offers me the opportunity to be able to play hard. This lesson generalized to many other lessons. I quickly learned that if I had to work for things, I could not afford to be a "slacker." I needed to be a sober, clear-minded kid who was able to get up on time and not be late for my work obligations. This carried through to my schoolwork as well. I did my assignments on time so that I had the time to work for what I
wanted. After awhile, I actually can remember that I consciously said to myself, "If I have to do my schoolwork, then I might as well learn what it is I'm studying." After awhile this really paid off, too. I knew the material, and studying for examinations became less time-consuming and almost seemed like a review process.

I am not here to tell you that my childhood was immersed in a "utopia." - I certainly had my moments of laziness and desire to "act out." But I was always able to remember that when I was in the "zone," I could accomplish things.

Parents often believe that if they were not afforded something as a child, they have an obligation to get it for their kids. This all-or-nothing notion is simply not healthy.

We owe our children the knowledge that they are only limited by their own motivation or lack thereof; that they can, indeed, accomplish anything and everything. Youngsters must have the knowledge that it is their life and that they can make the most of it. Parents must model this for their children; stop handing over everything your child's heart desires, and do the right thing. Help your kids to be motivated to live healthy, productive, purposeful lives.

The ego has always been referred to as the "executive of the personality." It facilitates the id to delay its need for immediate gratification (think of the id as that part of the personality that "wants what it wants when it wants it"), like the need to quell a craving.

The ego puts some reality in the personality game and says: "Well id, you must come up with a plan that is reality-based before your needs can be met."

To accomplish this executive function, the ego utilizes what is referred to as the reality principle. All those instinctual aspects of the id are powerful forces that can result in an individual disregarding the reality that we live in a law-abiding society, and cannot simply do as we please!

So, the ego takes on important decisions by using intelligence to learn -- in other words, it has the capacity to utilize cognitive functioning, unlike the id which can be thought of as the "big baby" and cannot think logically for itself in an effort to protect us.

In the aforementioned paragraphs, you can see how the ego could play an important role in controlling id-oriented desires to use drugs and alcohol, leading to addiction. (The reader is reminded that this blog is dealing with theoretical constructs first postulated by Freud to understand the personality. Of course, there are biochemical explanations that explain addiction in more tangible terms, but that is for another blog.)

The ego also is referred to as the "self." When people abuse drugs and alcohol, they allow themself to be given over to their id-oriented drives and don't enable the self to take the time to think the drink or the drug through -- to deal with the reality of the situation.

Time and time again, I have parents who come to my offices who are in recovery and cannot understand why their youngster does not yield the genetic reality that they must be careful with alcohol and drugs because of a predisposition to the disease of addiction.

It would seem that tweens and teens have egos that don't want to think the drink or the drug through; that don't want to weigh the variables that would inform them that experimental use of drugs and alcohol is a dangerous street to go down, particularly given a familial history.

Instead, their id gets the best of their ego and the reality principle seems to be placed in the background, in favor of what they perceive as the need for immediate pleasure, what Freud termed the "pleasure principle."

These youngsters lack the self-control to deal with peer pressure and have poor "ego-strength," succumbing to the same errors in judgment that their parents made, only to result in their moms and dads wondering just what it was they were thinking.

The problem is that the youngster believes he or she is immortal and simply is not engaged in thinking! Instead, he or she is caught up in the immediacy of the moment, on an existential journey to try and find themselves. How ironic!

As part of a peer group, each teen yields to and at the same time influences the other to make the wrong decisions. AA refers to this type of cognitive process as "stinking thinking" and encourages testing reality by attending meetings where individuals can hear others over and over again, in an attempt to appeal to their logic; to bore a hole into their psyches and reinforce the reality principle.

Another aspect of the ego, is "self-efficacy" -- one's belief in their ability to accomplish a task. Teenagers, percolating with biological, psychological, and social changes, lack a great deal of self-efficacy. This only makes it harder to resist id-oriented urges for experimenting with marijuana, MDMA, opiates, alcohol, etc.

Ok, so what is the answer? I believe the answer lies in responsible parenting from a very early age. One is born with an id in tact, and then goes on to develop an ego. So the sooner parents set boundaries and teach rules and regulations, the basic dos and don'ts, avoid acting like their child's friend instead of their parent, the better the chance that the youngster will build up an armormentarium that leads to strong ego defenses that can fight the relentless forces associated with the need for immediate gratification. You would not allow a young child to touch a hot stove; why not attempt to disallow the teen from smoking a joint?

Things like zero tolerance for drugs and alcohol may seem unrealistic, but they must be firmly entrenched in core family values.

Yes, experimentation may still take place, but consistent messages make for a stronger sense of self-worth, which in turn gives the youngster the self-esteem and self-efficacy to stand up to peer pressure.

Perhaps old Sigmund could still teach us a thing or two -- even this cognitive behaviorist!

I recently appeared on the television program, "Inside Edition," to discuss the new drug concoction "sizzurp."

It consists of a combination of a rather old antihistamine drug known as promethazine in combination with codeine syrup, which is a rather potent opiate.

Fruit flavored soda (usually Sprite or Mountain Dew) is then added as well, and (if you can believe it) Jolly Rancher candies!

It is all placed in a styrofoam cup and because of the codeine syrup usually appears purple in color.

Between the codeine and the promethazine one experiences a sense of euphoria with impairment of motor skills.

If one consumes enough sizzurpp, he or she can experience seizures, as well as a drastic suppression of lung and heart function - which can lead to death. If you're lucky, perhaps you will only stumble and break an arm instead of causing a concussion!

Here is what troubles me: Why can't tweens and teens learn to "live life on life's terms?" Are the games offered on computers making their virtual world so wild, that an in vivo experience just seems empty, dull and drab?

Whatever happened to the excitement a youngster feels smelling the spring air, having a first crush, going swimming and diving and skiing, and skating, or smelling the nutty roasted smell of popcorn at the movies?

Perhaps I am missing something, but I'd much rather be hiking through the woods than doing something like sizzurp! I'd rather fly a kite, or body surf the ocean waves! I'd rather read a book and use this thing called an imagination, rather than risk a seizure!

Social media is a fascinating phenomenon comprised of dialogue between individuals in a vast "virtual" world. Certainly, it facilitates the information super highway, in transporting and delivering news rapidly. But what about the veracity and value of that information?

I believe when a site takes on a worthwhile issue -- gun violence, a health issue, or helping to de-stigmatize mental illness -- it grows in value. Of course, it must be a balanced presentation; one that is based on facts and not speculative nonsense.

Specifically, I want to focus on the use of social media around the issue of mental illness and gun violence.

Mental illness and gun violence have been linked in the media more than ever since the tragic shootings at Sandy Hook Elementary School on Dec. 14, 2012, when Adam Lanza, 20, fatally shot 20 children and six adult staff members in a mass murder in Newtown, Conn. Lanza is mentally ill and the tendency is to want to blame his behavior upon his mental illness. Yet the truth is, these tragic circumstances were the exception not the norm. The pure indisputable fact is that mentally ill individuals rarely act out with behaviors that lead to violent killings (NIMH, 2012).

One could say even one act of murder is too many, but then again this could be said about any grouping of individuals who carry out an act of violence.

It is far more often that individuals diagnosed with a psychiatric condition are the victims of violence, rather than the purportrators of it (NIMH, 2012).

So I call to all social media outlets to utilize the far-reaching exposure they have; just choose salient issues, and research the facts.

Let me ask a question: If a human being is not declared dead until brain dead, why can't we accept that mental illness is an actual disease?

And since the "Diagnostic and Statistical Manual of Mental Disorders," Fourth Edition, the Bible of mental illness, includes addiction under the category of mental illness, then addiction is an illness, too, correct?

It puzzles me as to why we look at cancer, diabetes, COPD, hypertension, and other diseases but not addiction and other mental illnesses. The previously mentioned prombles all are primary, progressive, chroni, and if untreated fatal. So are most mental illneses. And yet, somehow, schizophrenia, bipolar disorder, depression, and alcoholism fall in to "weird states" that can even be seen as having elements of moral failing?

Mental illnesses are, indeed, disease: If you think alcoholism is not primary, progressive, chronic, and if untreated fatal, then perhaps you need to be educated (and maybe have your head examined!).

The stigma attached to the disease entities related to the mind is devastating to the individuals who suffer from them. Where is our compassion? Where is our intellect? Where is our understanding of scientific, evidenced based literature? I certainly hope that Descarte's and James' fascination with mind-body theory will not just fall by the wayside.

What is the matter, people? It is 2013 and we still too oftten castigate those whose illnesses reside in their minds with statements and belief systems life:

"It's all in your head"; "You are one card short of a full deck"; "a few beers short of a six pack"; "knitting with only one needle."

When will this stop?

I believe as a doctor of psychology, a student of psychological research, and above all, a human being that it truly is embarrassing to all of us to continue to view a brain disorder as anything else then the disease that it is, just like any other illness in the human body.

Let's hope that further research and caring, comprehensive treatment, will pave the way to erase such ignorance.

In the 30 some odd years I have been in the field of psychology - specializing in co-occurring disorders, it is inevitable that at some conference I am always asked about psychiatric illness predating addiction, or addiction predating psychiatric illness.

As I point out in my book: "The PDR Drug Guide on Pediatric and Adolescent
Mental Health," which I co-authored with Michael Behar, MD, (Thomson Reuters, 2008), addiction is classified according to the "DSM IV," (American Psychiatric Association, 1994), as a mental disorder.

Certainly anyone who is actively drinking alcoholically, or using licit or illicit drugs to their detriment, is not in their right state of mind. We accept this as fact; however, we still get caught up in the "chicken and the egg" scenario.

Perhaps, this has to do with self-medicating behavior (do psychiatrically ill individuals self- medicate with alcohol and/or drugs, or do some individuals use alcohol and/or drugs to the point where they poison organs such as the liver and brain, developing various psychiatric conditions).

Any time a doctor of psychology, psychiatry, or any qualified mental health/addiction specialist conducts a psychiatric anamnesis,
they must ensure that they look at the identified patient's matriarchal and patriarchal genetics - is there any evidence of psychiatric or substance abuse history on either side of their family. This might seem rather obvious, but I can assure you it is often overlooked.

A good history must clearly attempt to reveal whether the individual had psychiatric issues prior to using substances, or perhaps only developed such symptoms from using substances.

I like to reinforce among my psychiatric addiction fellows to take their time. Unless an individual is truly suffering from psychiatric symptomatology, don't rush to prescribing something, and if you must, make sure it is nothing addictive such as a benzodiazipine. Once again, one might think this is rather obvious, but I cannot tell you how many times I have seen an alcoholic individual with anxiety and depression given a benzodiazipine - an addictive substance that is classified as a central nervous system depressant.

There is an old saying in medicine: "When you hear the sound of hoof beats look for horses not zebras." The truth is clinicians need to be orderly, careful, and deliberate, and the obvious will reveal itself!

As I write this, it’s New Year’s Eve in Connecticut where it has snowed about 4 to 6 inches. I decided to shovel the stairs so our guests would not fall. As I shoveled, I slipped and felt a pop in my back. It seemed OK at the time, like no big deal—at least that was what I thought.

Later that evening as the clock struck midnight, everyone toasted each other. There were many wishes for a "prosperous year," wishes for a "peaceful year," and also wishes for a "healthy year."

Of course, it is nice to have money and certainly we need peace, but the next morning when I awoke and discovered I had the worst pain in my back and could not walk, I realized a "healthy year" was the most important!

By midweek I was in such pain I had to have an MRI, and discovered I had a "bulging disc." This led to an epidural, and let's just say the new year has been filled with unbearable pain.

I truly am not a pill taker—and no, although I am an addiction specialist, I am not in recovery. I just like to feel my feelings and never was one to go for altering my consciousness. So, opiates were out.

The pain I have endured has been, well, frightening. It’s hard to walk, sleep, work, etc. While I was assured that I will be OK and things will get better over the next week or so, it has really been tough.

We know addiction is a disease involving the brain and certainly affecting the liver and eventually every organ in the body. My fall was an accident that I believe I could not see coming, and therefore could not prevent. Addiction, however, is preventable. It can cost someone their life in so many ways — health, family, friendships, self-respect, education, employment opportunities, and the list goes on.

How about for the new year, those of you fighting with this truly devastating disease, double your efforts to do everything in your power to get and stay sober. After all, good health is truly is the best wish of all for the new year!

Once upon a time there was a six-year-old little girl named Alexandra. Alexandra had huge hazel green eyes and always had her hair up like Audrey Hepburn. Many wondered how such a little girl born in the late 1980s knew of Audrey Hepburn, but I can assure you she did.

Alexandra always liked to follow her father around the house and yard. She would enter her father's study while he was writing a paper and gab away at him until his mind was full of the thoughts of a six-year-old and he could no longer write the latest study he was engaged in working on.

One day in the winter's chill, Alexandra's father went out in the yard to fetch some wood for the fireplace. Alexandra always was attached at the hip to her father so he really did not notice her when he gathered a piece of wood and as he went to place it on the cloth carrier accidentally hit Alexandra in the eye with one log!

The father was so sorry as he had not realized she was behind him. (Perhaps his mind was preoccupied with one of his studies.)

Let’s get back to the story.

The father gathered Alexandra in his arms and ran to the house to fetch some ice for her quickly blackening eye. Alexandra had so many tears and the father and mother felt so bad as they explained to Alexandra that it was an accident.

Now, in this land there was a shop called Bloomingdales, and as the father's guilt for giving Alexandra a black eye was growing by leaps and bounds (even though it was an accident), he took Alexandra and the mother to buy Alexandra a very expensive coat that was red, warm and comforting. Alexandra really had wanted this coat and hoped that the great Santa Claus would bring it to her, but the father insisted that the jolly old elf might not get around to it. He too might have been busy working on a paper like the father, and so it was wise that the father purchase it.

The sales lady at the great department store was grandmotherly and sweet to Alexandra—that is how most people were to Alexandra who appeared to be a great ballerina in a six-year-old's skin. The father thought to himself—was it Alexandra's charm that made the clerk so friendly or the commission on the expensive coat?

When the sales lady said to Alexandra: "You must be a wonderful little girl to have a mother and father love you so much to purchase you such an expensive gift," Alexandra replied: "It is because my daddy hit me in the eye with a piece of wood!" The father and mother quickly explained the accident that had occurred, as they saw the flush come upon her face and her mouth drop open.

This story is about a little girl of six, and the accident that happened and the love that made a father and mother purchase her a very expensive gift that would turn her tears into a smile. This is the type of story that we all have about our children when they were, are, or are about to turn six—a sweet tale about the things we remember and the happy but funny endings they have because of something the little one says or does.

This is the type of story that we tell for years on end that brings a smile to all our faces as we recall the sales woman's shock at the little girl innocently stating that her daddy hit her in the eye with a piece of wood— that is, until the mother and father were able to explain the accident and resultant father's guilt.

Until last Friday, this was my most frequent memory of the age of six— now that is all gone. For the people of Newtown, Conn., our country, and the world I close today's blog with the words of Tiny Tim: "God bless us, every one!"

I remember when I was growing up in the ‘60s and ‘70s. I would never dream of doing some of the things I see teens and even tweens doing today.

If I ever used foul language with my parents, or even during the drug laden "hippie" era, so brazenly used mood-altering chemicals without at least thoughts of serious consequences, I just would not have been properly in touch with reality, even when I was sober.

I don't want anyone to think I am in favor of hitting youngsters - it certainly sets the wrong example and has been clearly shown to result in the opposite outcome from the one a parent is trying to achieve; however, in the absence of corporal punishment, a parent can still teach responsibility.

Under my model of "carefrontation," one learns to treat people (including adolescents) with respect and dignity - never shaming or blaming them for having a problem. But the identified patient, let us say a 16-year-old, still must understand that they must meet certain responsibilities - whether for addressing their addiction or even seeking therapy or taking medication for a psychological issue.

When did parents become so soft - so enabling? Enabling one's children to continue to display deleterious behavior is simply a shirking of parental responsibility. As a baby boomer (one who is born between 1946 and 1964), I believe my generation has tried to give our children more than we had - most of us grew up with the Great Depression always in the background and our parents tended to not want to spoil us. Then we became parents, and reacted by wanting to give our kids everything. The result is a generation of youngsters feeling entitled and not truly understanding their responsibilities in the conjugal family.

If we can simply understand this as parents without becoming defensive, we can slowly correct the problem. It is not about punishment but dialogue that supports responsibility. Not a choice but a mandatory duty to deal with "life on life's terms" that we must begin to inculcate before (and I truly mean this) our society is doomed.

We often hear of “imperfections of character” in recovery. Some of them can include: being too serious; jealous; dishonest; prideful; arrogant; cynical; argumentative; lazy; conceited; judgmental; selfish; insecure; etc. I think at times we have all shown some of these “defects.”

Now, before you think you are a "flawed" person, I believe many of these characteristics are just part of the human condition. The key is to what degree you showcase these “inadequacies.”

I know in my own life, that despite being a psychologist, I too, can be conceited, judgmental, cynical, argumentative, etc., and this is after many years of professional study and therapy – well again, I am human! I also believe I have a good sense of humor and this certainly helps in the process of forgiving myself, striving to improve.

Taking oneself too seriously is always a problem because if you do that, then it is nearly impossible to look at yourself.

First things first: relax and accept that every human being has “character flaws,” and that does not translate into a personality disorder (unless it becomes so dysfunctional that it gets in the way of one's life.) I know that at times I am trying so hard to help my patients to feel accepted, that I may illustrate something utilizing myself, and it blows up in my face. But I always have to remind myself that my intentions were good. The vast majority of my patients, friends, and certainly my family, have taken the time to get to know me and realize that I am just being “Dr. Stratyner,” or “Harris,” and that I am the first person not to take myself too seriously.

We all have an ego – the self that attempts to defend against narcissistic injuries with myriad defense mechanisms. Aren’t many of the” flaws” I mention in essence types of defense mechanisms? They may not always be the highest order defenses that we can use, but they certainly have their place. Hard to believe that being too serious, jealous, dishonest, prideful, arrogant, cynical, argumentative, lazy, conceited, etc. can actually work in the service of one’s ego. Think for a moment how laziness, cynicism, or pride can actually protect us.

Let us say you have a sense of low self-efficacy (one’s belief in his or her ability to accomplish a task) around a particular endeavor – wouldn’t laziness serve a purpose? Or perhaps you are afraid to admit that your friend is right and you are wrong because of a feeling of cognitive dissonance (the feeling of discomfort when holding two or more conflicting thoughts), for example, your deep belief about something and your friend’s opposing belief which you find plausible – wouldn’t cynicism serve a purpose? Perhaps you make an embarrassing error and feel “less than” – doesn’t pride serve a purpose? A justification to allow you to not admit you were wrong?

Suddenly, we see that these so-called “character flaws” may simply be “techniques” to prevent a bruised ego – indeed, one usually goes about life without even having knowledge that they are utilizing such maneuvers.

And here enters therapy – cognitive or psychodynamic, role play or gestalt. It really doesn’t matter as long as it makes the individual aware of her or his tactics, which if go unchecked, become part of how others brand you.

The most important thing one can do to improve oneself is be open to feedback. Don’t forget to have a sense of humor (the highest order defense), don’t take it all so seriously, and finally, believe that as long as you are breathing you have the capacity to change. Now, that is an impressive character trait!

In all the years I have worked in the field of psychology — as Division Director of Addiction Services at New York Presbyterian Hospital, Weill Cornell Westchester, Director of Addiction at Mount Sinai School of Medicine where I continue to serve as a Clinical Associate Professor, or in my current role as a Vice President of Caron Treatment Center and New York Regional Clinical Director— I always run across colleagues who believe that relapse is a given.

Let’s be clear. It is not!

There are individuals who enter recovery and continue in recovery—as Caron Treatment Center always stresses, it is important to be sober and not simply abstinent—which, in this clinician's mind is the pivotal variable that separates those individuals who are able to avoid relapse, from those individuals who find themselves relapsing time and time again.

Is it OK to relapse? Of course one must accept the notion that it is "OK" to relapse, but certainly, the general consensus is that it is better if one can avoid it.

We understand relapse to a much greater extent, and forewarned is forearmed—particularly in terms of knowing what one's triggers are.

Perhaps the most important thing to remember when it comes to preventing relapse is that one gets sober to make their life better, not worse. Otherwise, why would one focus on giving up a drink or a drug?

I cannot help but think of the parable of the man who felt sorry for himself because he lost his shoes— until he saw the man next to him who lost his feet.

In the recent Sandy storm, I lost a new Vespa and my classic sports car, which I spent years working on — it was my "baby." But compared to the devastation that many people went through, mine was just material.

Funny, I thought of a comparison to how peoples' lives were in shambles, and the disease of addiction— homeless, lost, at times without hope, grasping for something that resembles the familiar, the safe.

Perhaps individuals who have never really understood the disease of addiction should think of it as an "internal storm" — one that churns inside and destroys families in the wake of the identified patient. Yes, addiction is the hurricane within that leaves lives in tatters and is unforgiving as it ravages those innocent souls that perhaps never saw it coming.

Some of you may get angry at my analogy. After all, you may say, Storm Sandy hurt innocent victims who did nothing wrong. Well, if addiction is truly a disease, and as a clinician and researcher I know it truly is, then the lives it destroys in its wake are innocent as well.

Governor Chris Christie of New Jersey warned many to evacuate those regions that were most susceptible to the storm, and I now remind those with addiction in their families; heed the warning — save yourself by taking responsibility.

Ever think about poetry? Whether it is a simple rhyme, a more obscure verse or a lyric to a song, it is always a creative process.

The poet creates a story of sorts, which springs forth from his or her mind and places it on paper for other people to read or listen to when set to music. Indeed, it is a gift from one individual to be shared by many. In essence, one might say the poet has to "Give it away to keep it" — to have the thought behind the poem perpetuated.

Recovery is a poem. It is a gift that is given, whether by a professional teaching a class at a rehabilitation facility or a member of a Twelve Step group sharing his or her experiences, allowing someone else to benefit. One might even say it is a gift from a person to her or himself.

Life is such a diverse mystery of conceptualizations. Our reality is ultimately what the living perceives it to be. You see, psychologists know how important perception is — hearing, seeing, touching, smelling, experiencing our positional orientation in the world. It is important because we need to know if the individual is experiencing reality or has gone beyond reality. Yet, the ultimate reality is always unique in some way to the individual. Psychologists establish parameters to measure that reality, but again, ultimately it is very individualized.

Thus, when "the poem" of recovery is received as an offering — be it as a gift to oneself or in the form of one individual helping another — it is based on a parameter of perceptions as well as unique circumstances.

Nobody can truly know what an individual is feeling or thinking when it comes to her or his own recovery except the individual. Yet, "the poem" of recovery is offered in the context of a parameter of those experiences that one does indeed share with others — those threads of common experience when someone in the "rooms" has that "ah-hah" moment and is able to say, "I share a common bond." Even though my recovery is ultimately unique to me, it is within the context of others' perceptions.

Think of it this way: a patchwork-quilt can be made up of different squares that are designed by different individuals, but when they are sewn together to form the whole quilt, a new meaning is derived.

There really is nothing new here. The concept of the "gestalt" is defined as "the whole being different than the sum of its parts." And yet, without the individual "parts" being blended together, there would indeed be no whole.

Recovery, much in the same way, is a blending of unique, individualized, experiences together to form a common experience that leads to sobriety. The poetry of this process is almost like alchemy and we see that the individual is transformed into a "new being," like coal into diamonds. In essence, all those with the disease of addiction have the capacity to be sober. They simply (and it is not always so simple - but you will allow me poetic license here) must listen to their unique poetry within as well as the poetry of others and find that common thread.

Image courtesy of stock.xchng.com.

In the past two weeks, I have done interviews for various websites and TV regarding the growing interest in the newest designer drug, Smiles.

Smiles has most recently been implicated in actor Johnny Lewis’ violent death, which resulted in him allegedly murdering his landlady before falling to his death. Prior to the tragic news about Johnny Lewis' death, the drug was also implicated in the deaths of two teenagers from East Grand Forks, N.D.

So what do we know about Smiles? It is a type of psychedelic drug known as a phenethylamine called 2C-I.

2C drugs are not simply hallucinogenics but have a "twist" - they also have stimulant effects, which are not unlike ecstasy. So, one can envision LSD and amphetamines in a potentially deadly chemical compound.

Historically, 2C drugs were first discussed in a 1991 book by Alexander and Ann Shulgin entitled: "PiHKAL (Phenethylamines I Have Known And Loved): A Chemical Love Story." Some say Shulgin is the Timothy Leary of 2C drugs.

2C-I, like many of the 2C drugs, result in not only visual and auditory hallucinations, but due to their stimulant aspects, can cause elevation of heart rate and increases in body temperature. This obviously could lead an individual meeting a violent death, like walking off a building, on to train tracks, or experiencing a stroke, severe heat prostration, dehydration and imbalances of electrolytes. In terms of brain function, on a neurotransmitter level, dopamine receptors as well as serotonin receptors are affected - much of this is based on speculation from research with other synthetic compounds.

Just as we have started to try and relax about bath salts (a drug which is based upon a shrub-like plant that has a component in it called cathinone and can be synthesized for its hallucinogenic properties), and K-2 (a form of synthetic cannabis that is a blend of herbs and synthetic chemical compounds), along comes Smiles.

“Smiles” looks like powdered sugar, and can also be seen in pill form, but less often. As I said on WCBS-TV New York, “It’s a very, very, very dangerous drug that is being marketed through the
Internet. Teens mix the white powder form with chocolate or other confections, and they
eat it like candy."

The "roller-coaster high" is often accompanied by nausea, vomiting, anxiety and panic attacks. As I stated earlier, this drug has a strong potential for resulting in fatal dehydration, arrhythmia and stroke. Ironically, its victims have smiles on their faces.

The DEA has been quick to classify 2C-I as a Schedule 1 substance, making it illegal to manufacture, distribute or possess. Still, reports of teens using smiles across the U.S. are popping up rapidly, which can be largely attributed to teens' tendency to spread "misinformation" through chat rooms.

Let me clearly emphasize that parents need to sit down with their teens to educate them on the dangers of Smiles, and all of the synthetic drugs. Do it fast, because there is nothing funny about this drug.

When I was becoming a doctor of psychology, from the first course I took in school, the topic of nature versus nurture constantly came up. I never really framed it as one or the other.

I mean, we know we have genetic factors that affect our intelligence, and we interact with the environment, so to me, it was rather obvious that it was nature AND nurture. (This is not what this specific blog is about - I will leave that to my research colleagues who focus on that area). But I wanted to raise nature and nurture as a "lead-in" to discuss book smarts versus street smarts.

I believe in today's world we need both.

If I want to learn reading, writing and arithmetic, I usually need some form of book smarts. I suppose I could learn quantum physics by interning with a quantum physicist, but I know I will be cracking a book for sure (and obviously that is putting it mildly). Similarly, I suppose I could read what it is like to live on the streets in a tough urban environment, but I know sooner or later I will need to do so if I fully want to appreciate the experience.

Books are something I love, and lord knows I have literally read hundreds and hundreds to become a psychologist, but I also needed to work for years and years in the trenches with patients to develop very specific clinical instincts - what I refer to in many of my writings as "clinical savvy."

I could read Irvin Yalom's classic, "The Theory and Practice of Group Psychotherapy"— and indeed, I have — and savor his 11 therapeutic factors to running a successful therapeutic group experience; yet, being in a group and running a group really completed my education.

I come across a great deal of budding Bill Gates who want to drop out of "their" Harvard and start their own Microsoft, but I am not sure that without the university and graduate school experience, they will make it as big as Bill Gates. Let's be frank, even with higher education they probably will have a tough time - but many are looking for a shortcut and they rationalize taking that shortcut by pointing to Gates.

OK, so what am I saying? Well, you need common sense and experience (my operational definition, of "street smarts"), but you also have to pour over the books, take the classes, listen to the scores of lectures, if you want to increase your odds of success. So, it will always be vital to "jump in the pool." But first, perhaps you should take some swimming lessons — there is always the exception — but let's face it, what I am calling for is probably more the rule.

This week's blog is in the form of bullets - it gives you some of the latest facts about marijuana. You may not like them but they can be backed up with credible scientific studies too numerous to provide here without specific requests:

Today's marijuana is not only psychologically addictive but capable of being physiologically addictive as well

Marijuana does have carcinogenic properties that are as dangerous as cigarettes

Image courtesy of Salvatore Vuono/freedigitalphotos.net.

"The unexamined life is not worth living," so said Socrates - and perhaps truer words were never spoken! If one has an addiction, be it to a chemical or a process such as gambling, acting out sexually, spending, etc.— as I said in my last blog— it is not ever enough to simply abstain.

Why would someone not want to get sober? Be clear of mind and honest? Think about others instead of constantly engaging in a "narcissistic exercise?" Understand what makes him or her tick so that the individual is comfortable in their own skin?

I have always been a student of Lao Tzu (even before Wayne Dyer brought the great philosopher to the minds of millions as only Dr. Dyer can do.) Lao Tzu once said:

“Simplicity, patience, compassion. These three are your greatest treasures.

Simple in actions and thoughts, you return to the source of being.

Patient with both friends and enemies, you accord with the way things are. Compassionate toward yourself, you reconcile all beings in the world.”

It is only through the true examination of one's life that understanding can lead to a sober, simple and accepting peace of mind that allows all of us to be at one with the beings that surround us - even those we do not agree with. This sobriety is the gift we derive from the journey of abstaining from those things that lead us away from introspection - an introspection that derives from accepting that there are powers greater than ourselves that connect us to all of humanity.

Why would one want to abstain from an addiction if their life did not change for the better? If they could not develop a sense of love and compassion for all living things? A profound attempt at trying to be one with the universe? This may hit some as psychological or spiritual dribble - but those are the folks who stay "dry" instead of getting sober.

Acceptance is such a simple concept but much harder to achieve - yet if one tries to reach a state of acceptance they will find themselves so much happier, filled with positive thoughts that lead to a much less stressful state of mind. That is why therapy, be it individual, gestalt or cognitive, etc., should always be seen as a gift to oneself - not a sign of weakness but a harbinger of strength.

This is what this psychologist is expressing - to examine one's life is to go on an honest journey that logically will eventually lead to a deeper understanding of humanity.

Image courtesy of stock.xchng.com.

Often, individuals with addiction issues have a related psychiatric issue - particularly if you include personality disorders in the mix. According to the National Alliance on Mental Illness (NAMI), 37 percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness.

It is not enough to simply believe that if a person addresses his or her alcoholism or other drug addiction(s), that all their problems will be resolved.

For example, this clinician is a huge fan of Twelve Step programs and believes they are an integral part of a well rounded "treatment plan." However, it is equally important that the person seeking sobriety be in professional treatment in addition to working a self-help program - especially if the individual has mental health issues such as bipolar disorder, or perhaps a borderline personality disorder.

Treatments such as cognitive therapy, and when necessary utilizing psychopharmacology, are very important to folks with co-occurring disorders.

Any individual with an addiction should receive a professional assessment that includes looking at a potential family history of addiction and psychiatric illness.

Whether an addiction professional or mental health professional conducts this assessment, they must be trained in both addiction and mental health issues - don't just assume that they are!

It has only really been over the past 20 years or so that clinicians are starting to understand both of these specialties, and still you will find many counselors and clinicians, who lack expertise in one area or the other.

Don't be afraid to ask your treatment professional what their training is - this is your life or the life of a loved one we are talking about!

There are so many issues that the co-occurring individual faces: did the addiction lead to the mental illness or did the mental illness lead to the addiction?; as previously mentioned, is there a genetic history of one or more illnesses?; has the patient ever been on medication - such as a benzodiazepine (eg., xanax) - if so, did the person who prescribed these medications understand that any medications that are addictive should NEVER be prescribed; does the patient's family and friends, and especially their sponsor, understand that someone who has a debilitating, independent psychiatric condition, may benefit from medication? (For example, with endogenous depression, which is a type of depression caused by biological factors rather than reacting to something in the environment, therapy can be enhanced - even made possible, with the prescription of an SSRI or other non-addictive medication). The list of concerns goes on and on.

As the reader begins to see, there are important issues which arise as we delve into the world of co-occurring disorders - I was just touching the tip of the proverbial iceberg!

Given that it is the 21st century, it is time that we realized treating an addiction may not be as simple as we once thought - it requires (in this clinician's over thirty years of experience), self-help, as well as professional help.

The good news is that people can get better regardless of their diagnosis or diagnoses, but we must open our eyes to comprehensive, inclusive approaches.

Image courtesy of Ambro/freedigitalphotos.net.

I can recall vividly, that as the summer would wind down I would begin to ponder about the fall—returning to school was always number one on my list.

Depending on what age I was, I would anticipate the social interactions that would take place—would I make friends easily? (I particularly can recall this anticipatory anxiety in the first grade.) Now, that's what psychologists refer to as a fairly regressed memory.

It is quite normal for a child and even an adolescent to have some anxiety about starting school for the first time—or even returning to school.

This is also particularly true for parents who are worried about their kindergarten student who is going "off into the real world," or the college student's parents who are experiencing separation anxiety.

Here are some tips to ease the process:

* Any time a youngster begins a new school year—be it kindergarten or college—it is a transition for both student and parent. Acknowledge the transition and dialogue around it with your child in an age-appropriate manner

* Recognize that one size does not fit all—it may seem obvious, but oftentimes parents do not take their children's age into account or other important variables like siblings who are older or younger, starting in a new school after moving, the child and the adolescent's personal problems such as ADHD or drug issues, or even something as basic as sleep habits

* Get the preparation out of the way—prepare clothes, purchase school supplies and make sure your child is part of the process. He or she must take ownership; even the kindergartener has a right to have a say about something they will wear (within reason)

* Don't be surprised if tears are displayed—by mothers and fathers who are sending sons and daughters off to college, or youngsters who are starting high school. Prepare for it by discussing feelings—again in an age-appropriate manner. Make sure there is no blaming or shaming by anyone including a sibling

* I even had parents have a multiple family support group—"misery loves company;" or perhaps a better way to put it is "share the joy."

* One last tip: Remember the saying: "This too shall pass." Along with the first tip, remember that life is indeed a series of transitions that can and usually are dealt with effectively, and then growth occurs and we move on to the next phase!

Now, all of you get to work!

Image courtesy of stock.xchng.com.

As many of us who work in the addiction as well as mental health world know, many patients experience shame around the stigma of what is perceived as a "moral failing" or psychological weakness – despite the fact that addiction, as well as mental illness, are diseases and are thus primary, progressive, chronic and if not treated can be fatal.

This shame often leads to patients who spend good money for psychological treatment to lie to their respective therapist. This is somewhat ironic because confidentiality laws are so stringent. The whole idea of seeing a professional is to be honest and seek the help one needs.

Yet, defense mechanisms such as denial, projection, rationalization and etc. result in therapeutic hours that are spent, at times, in falsehoods. It is the counselor's job to break through this resistance that comes in the form of lying so that real issues can be professionally addressed.

This process involves developing what is referred to as a "therapeutic alliance"— forming a bond that develops trust between counselor and client. It is the only way that hope is nurtured.

If you are going to see a therapist make sure you are comfortable with that individual. You can even "shop around" until you find the right fit. It sure beats wasting your time and hard-earned dollars when the professional simply wants to help.

Image courtesy of Ambro/freedigitalphotos.net.

From Kierkegaard to Dostoyevsky, to Nietzsche to Sartre, man has always been interested in "authentic" existence. This experience comes to my mind very strongly as I reflect on the Colorado movie massacre.

You wake up one day and decide to go to a picture premiere— a midnight showing of a movie series that dates back to a comic book that first appeared in the early ‘40s. You are excited about the mystery and fun that combine to create what was referred to in the ‘60s as "a happening" – an experience shared with friends and strangers that would unfold through some form of creativity. In this case, a film.

Then all hell breaks out — every single human being's existence changes, whether they were there or through the media. Something that was anticipated with a mysterious joy turns into a real life horror. This is life.

This is the experience of shear existence that the living walk through, that our senses are filled with. Our minds are filled with a curious sense of the unknown that slowly reveals itself and dances between eros and thanatos—the opposing drives of life and death that Freud (1856-1939) so eloquently discussed.

For this clinician, the only way for me to make sense of the recent events in Colorado is to recall the character John in Huxley's Brave New World, who was willing to face tragedy in order to feel! I, like John, would rather live in our "brave new world," with all of its unknowns than to spend whatever is left of my existence in a computer-controlled calculated farce.

I feel fortunate that I am alive and privileged to be able to share my thoughts, knowing that so many others are not.

I have always related to my adolescents’ parents that raising youngsters is indeed the most difficult job in the world. You have to maintain and teach boundaries, while at the same time being approachable. What a difficult task trying to let your tween or teen know that you are their parent not their buddy, but that you love them and that they can come to you with any problems they might be having. That does not mean they will not be corrected, but it does mean they will be treated with love and kindness — oh, understanding as well.

Parenting should start early by teaching your children responsibility. If you can inculcate responsibility then you won't have to get to consequences to correct behaviors that lead to trouble—acting out with alcohol, drugs, failing in school, shoplifting, texting while driving—well you get the idea, but it is never too late to start.

As a doctor of psychology, I practice what I preach. I make sure the young folks I work with know they can tell me anything. They know I will listen and discuss issues with them, and that unless they tell me something that is threatening to themselves or others, what we discuss will remain with me.

Therapy is an art and a science, and I suppose parenting is as well. If you are a parent, you can read many books and blogs, but you ultimately have to find what resonates with you. Again, the principle of instructing responsibility is vital—it is based on "trust," which the Pulitzer prize-winning author Erick Erickson wrote about more than sixty 60 years ago in,Childhood and Society. Erickson noted that without trust, a burgeoning youngster never develops hope. Truer words were never written.

Adolescence is such a time of change. The cerebral cortex is developing, hormones are percolating and curiosity is the outcome. Yet, youngsters actually want rules and regulations. Study after study demonstrate that effective parents know when to say “yes” and perhaps, more importantly, when to say no (refer to Townsend, 2006).

Adolescents are learning—they have no roadmap! They rely on friends who are just as lost as they are, as well as misleading Internet posts.

Perhaps the most important thing a parent can do is stay in touch with their tweens and teens—ask plenty of questions and set rules. You run your household. You would not let a 12 or 13 year old drive, so why would you trust them to tell you they are sleeping over at a friend’s house who you never met and, "their parents will be home." Make phone calls, set rules and regulations, discuss your reasoning, but remember it is your reasoning and you will stick to your reasoning, your rules. Anger gets you nowhere, but boundaries get you everywhere.

Remember the old adage: "an ounce of prevention is worth a pound of cure." It became a cliché because it made good old-fashioned sense!

If you have any questions after you read this blog please write back and I will supply black and white, step-by-step responses. I am always happy to help parents raise adolescents that grow into well adjusted, effective, caring adults.

Image courtesy of photostock/freedigitalphotos.net.

I decided that I am going to talk about marriage this week. My wife and I have a 25-year wedding anniversary coming up in October. This blog is from a successfully married guy who just happens to be a doctor of psychology — but the "successfully married guy" thing is what I will lean on.

My wife and I are on vacation this Fourth of July week. So, if you cannot make an appointment, don't hear me live on my radio program, or see me on the TV news, that is the reason — word of my death simply is not true!

OK, now that I got that out of the way, you should all know that besides two days spent with my daughter and her boyfriend, my wife and I spend our holiday alone (that's right, alone) with our dog, Gertrude, at our beach home. We read, we eat, we sail, we scooter, take in concerts and plays, watch TV and boy do we sleep. Oh, we also bicker!

I like the word "bicker." It seems to be just right. It is kind of a romantic, passionate way to go back-and-forth in terms of arguing until one of you gives in and decides, "Oh hell, let them have their way." I must admit, I believe that usually turns out to be me — me as in I let my wife have her way. Here are some of the stupid things my wife and I bicker about: television, politics, sex, the dog, my driving, her driving, my weight, restaurants, movies, who will make the bed, throwing out the garbage, families, our daughter, our daughter, our daughter, friends, religion (she is Irish Catholic and I am Jewish), and the list goes on and on and on.

I suppose the reason we have stayed together so long is that the bickering is vibrant — it's alive damn it— it's alive! Sometimes when you’re in your 50s, it can take the place of sex. Sometimes it is followed by sex, and sometimes it is followed by my sleeping in the den.

My wife and I trust each other enough to bicker with gusto. It never becomes physical and the police have never shown up, which is a very serious topic I will save for another blog (i.e., domestic violence).

In the meantime, I want to point out that our bickering has never turned into threats of separation or divorce — as I tell my patients, there really is not much out there, so quit while you’re ahead! Too many youngsters today, in my opinion, are too sensitive. They have an argument and all hell breaks out and the next thing you know someone is contacting an attorney. I have referred to young folks as the "microwave generation" – everything must be immediate; no time to work through things!

I love my wife — yes and I am also in love with my wife. She is smart, compassionate, not afraid to speak her mind, takes people on, tells the truth and never, in my opinion, admits when she is wrong. By the way, I am not showing her this blog, it's better that way!

Image courtesy of Salvatore Vuono/freedigitalphotos.net.

I heard last week that there is a town somewhere on the east coast that is considering giving out fines to folks when they use the "F" word in public.

Despite my being described as a great liberal (which has become a dirty word in this country unto itself), I believe this action may be reasonable — if only to make a statement.

Filthy language used on the street (in front of children, adults, etc.), makes for a more disrespectful society — it creates an atmosphere of rudeness. Dr. Douglas Fields, a scholar of brain science notes that rudeness literally produces neurotoxins in the brain, thus rudeness leads to rudeness and creates a milieu of tension and angst.

I personally find it distasteful when folks use inappropriate language in front of children who may be passing by on the street. Think of the impressionable minds, and perhaps the parents who are trying to shelter their youngsters from such things.

Additionally, I am from an era when one did not wear jeans to work or the theatre. (I am not that old, but let's just say old enough to remember). Now we see disrespectful words, sayings and pictures on T-shirts. I remember when the flag was pledged to and not worn on a T-shirt, and yet I would be the first to fight for free speech (but I guess I always believed in some "judgment.")

I think our society has changed and as I said a few weeks ago, there simply is no turning back.

Maybe I am too old after all, to accept car alarms, and doors being locked, lobbying for legalization of mood-altering chemicals which effect the cerebral cortex, TV "news" people with political agendas and a continuation of hate and violence.

Oh well, as my mother once said: "Growing older is not for the faint of heart!"

I am known for a form of addiction and co-occurring psychology know as "carefrontation." You see many years ago I found that "in your face" therapy does not work! People can have addictions or psychiatric disorders and addictions, but they still have a right to respect — both are diseases and accusations have no room in treatment, when trying to help people. It is called treatment not confrontation.

So "carefrontation" states that individuals must be treated with no shame or blame — treated with respect and dignity, but because they may have serious diseases, held responsible for dealing with them.

You see "in your face" therapy simply raises defense mechanisms – it makes individuals feel threatened and that does not allow for therapeutic alliance!

If one is gentle and caring and helps the patient become ready to change, safe enough to take the risk to change, and feel empowered – has a sense of what Rotter called "internal locus of control," then there is fertile ground for recovery.

Caring goes a long way. Try it. Oh, but remember then must come the individual's realization that they have responsibility over their disease! Don't let your angst over your patient's illness or illnesses result in raising their angst! We are all just human beings – whether there is a "Dr." In front of your name, initials after or neither!

My wife and I recently had dinner at an extremely pricey restaurant across the street from Yale — I was in New Haven on business, and felt we could afford the more than $100 a person. I mean we both work hard — she's an oral surgeon and I am a successful psychologist, so why not treat ourselves now that we are in our 50s?

Across from us sat two folks who were in their early- to mid-20s. They ordered an expensive bottle of wine, appetizers, several main courses (one for each of them and one to share, followed by aperitifs and soufflés and coffee.)

Besides our visual eavesdropping, my wife and I were for the most part minding our own business (why would we “begrudge" these youngsters who were not our children?)

However, then it happened. They both brought out their respective iPhones and completely ignored each other – no interaction between the two of them the entire dinner. Oh, I stand corrected, at one point they did discuss an iTune download, but that was about it.

What's happening to us folks? Are we raising the next generation to be completely devoid of direct contact? What happened to talking with eye contact (oh, that's right we have Skype for that, how silly of me). Are we or have we created a new addiction? Talk about angst! I felt truly sad for them — I remember going on a date (yes, we ascertained they were on a date), and being so nervous. Would I have gotten a good shave? Would I have dressed nicely? Hair combed? Breath minty fresh? Been up on the latest news and gossip? Would I have been able to keep the conversation going or gotten a word in edgewise?

I wonder when the first iPhone rehab program will open — I can see it now: God grant me the serenity to accept the things I cannot accurately Google, the courage to download the iTunes that are obscure and the wisdom to know that human, direct contact is so, so important!

It's no secret that addiction is a disease. It is primary, progressive, chronic and, if not treated, fatal. I know this first as a clinician with more than 30 years in the field, and second as a researcher of co-occurring disorders (psychiatric substance abuse).

These days, I am very mindful that hope is waning. We see people die on “Black Friday.” We are filled with tremendous uncertainty and fear seems to lurk around every corner. Our safety as a nation is questioned. We are a part of a global village that

As long as you are willing to work with someone, there is hope that he or she might hear what you have to say

has to contend with environmental erosion and financial crisis. As a moral people, we have seen our values change—a diminution, if you will, of decency and respect for others. This is not to say that we have gone to hell in a handbag, but we do need to get back to caring a tad more. As Hillary Clinton once said, "It takes a village."

Usually, the first drink or drug is taken to self-medicate the fear that we experience – to escape the existential angst. After that, the disease takes over and we are off to an addictive process that spirals down a staircase of pain and suffering biologically, psychologically and socially. As a clinician, I'm keenly aware that human beings are always seeking to self-medicate their anxiety, depression, guilt or shame.

As the father of "carefrontation" in the science of psychology—as it applies to dually diagnosed individuals, I advocate for caring—much like a self-help program such as AA does. We need to embrace people with addiction issues and understand the process that leads to that first drink or drug—look for reasons to keep individuals in treatment and not for excuses to kick them out!

Although I do not represent AA, it is my understanding that one can go to a meeting intoxicated and, if they are quiet, be allowed to stay. This should be interpreted as "do no harm" of the highest calling—you can't treat an empty chair. As long as you are willing to work with someone, there is hope that he or she might hear what you have to say!

Psychologists learned a long time ago that trying to scare someone into changing does not lead to permanent change, but through care and education, responsibility for one's behavior can begin to be cultivated in the person's mind and real change can develop.

Ever think about poetry? Whether it is a simple rhyme, or perhaps a more obscure verse, or a lyric to a song, it is always a creative process.

The poet creates a story of sorts, if you will, which springs forth from his or her mind and places it on paper for other people to read or listen to when set to music. Indeed, it is a gift from one individual to be shared by many. In essence, one might say the poet has to "give it away to keep it"—to have the thought behind the poem perpetuated.

Recovery is a poem. It is a gift that is given, whether by a professional teaching a class at a rehabilitation facility or a member of a 12-step group sharing his or her experiences to allow someone else to benefit. One might even say it is a gift from a person to her or himself!

Reality Is Unique to the Individual
Life is such a diverse mystery of conceptualizations. Our reality is what we, the living, perceive it to be ultimately. You see, psychologists know how important perception is—hearing, seeing, touching, smelling, experiencing our positional orientation in the world, etc. It is important because we need to know if the individual is experiencing reality or has gone beyond reality. Yet the ultimate reality is always unique in some way to the individual. Psychologists establish parameters to measure that reality but, again, ultimately it is very individualized.

Thus, when "the poem" of recovery is received as an offering—be it as a gift to oneself or in the form of one individual helping another—it is based on a parameter of perceptions, as well as unique circumstances.

Nobody can truly know what an individual is feeling or thinking when it comes to her or his own recovery except the individual. Yet, "the poem" of recovery is offered in the context of a parameter of those experiences that one does indeed share with others—those threads of common experience when someone in the rooms has that "Ah-Hah!" moment and is able to say, "I share a common bond." Even though his or her recovery is unique, it is within the context of others' perceptions.

New Meaning in the Whole
Think of it this way: A patch-quilt can be made up of different squares that are designed by different individuals, but when they are sewn together to form the whole quilt, a new meaning is derived.

There really is nothing new here. The concept of the "gestalt" is defined as, "the whole being different than the sum of its parts." And yet without the individual "parts" being blended together, there would indeed be no whole.

Recovery, much in the same way, is a blending of unique, individualized, experiences being blended together to form a common experience that leads to sobriety. The poetry of this process is almost like alchemy and we see that the individual is transformed into a "new being"—like coal into diamonds. In essence, all those with the disease of addiction have the capacity to be sober. They simply (and it is not always so simple, but you will allow me poetic license here) must listen to their unique poetry within, as well as to the poetry of others, and find that common thread.

Joe Paterno had been the head coach of Penn State’s football team for 46 years. A man who, at 84 years of age, looks like the grandfather you always wanted, he was beloved—and still is—by many. His reputation has certainly been blemished, however, given the recent child sexual abuse scandal at the university.

Jerry Sandusky, 67, who was an assistant coach and part of former coach Paterno’s staff for more than 30 years before he retired in 1999, was charged with the alleged abuse of eight boys over a 15-year period—in other words, multiple felony charges. Indeed, last week two Penn State officials surrendered in Harrisburg, Pa., to authorities, charged with failing to report suspected abuse, and even the president of the university was forced to leave in the wake of the fallout.

If we all believe that that someone else will do the reporting, nothing will occur except the guarantee that more abuse will take place

While former coach Paterno was not himself charged, his decision in 2002, according to a grand jury report, to merely report to his superiors that a graduate assistant told him he witnessed Sandusky sexually molesting a 10-year-old male child in the shower rooms, but not bother to see what was going on, or report it to law enforcement officials, has ended his career in disgrace. It also led to the appearance that the former coach and other Penn State officials were simply interested in protecting their school’s reputation, and perhaps the up-until-now virtuous Paterno.

While Pennsylvania law only required that Paterno reported the incident to school authorities, which, as previously mentioned, he did, what everyone is asking is what about Paterno’s moral obligation?

This horrible situation raises many issues in this psychologist’s mind. Namely, why don’t individuals report child sexual abuse? Additionally, how can you tell if a child is being, or has been, abused?

Most folks simply don’t have the knowledge to truly recognize sexual abuse (which I will elaborate on later) and go into a state of denial that impacts their sense of moral obligation, not to mention that they don’t even begin to understand their state’s reporting laws. Of course, some individuals simply don’t want to get involved and worry about “making trouble” with their family, neighbors and colleagues. They feel anxiety over making things worse, and may also worry that perhaps the child will be harmed even more. But the greatest reason is the true belief that someone else will do the reporting. If we all believe that, however, nothing will occur except the guarantee that more abuse will take place. Bear that in mind!

Recognizing Sexual Abuse
With regard to recognizing sexual abuse, mood swings in a child—dominated by fear and shyness—and reluctance to visit with certain friends or family members is a sign that something may be occurring. Additionally, a sudden drop in self-esteem, dominated by not wanting to play with friends, can indicate potential sexual abuse. Also, sudden sleep issues, including reluctance to sleep, nightmares or frequent waking can also indicate abuse, as well as bed-wetting, or wetting or soiling themselves in general. Academic issues, such as suddenly stopping doing homework, a reluctance to even go to school or aggressive behavior in school can also indicate sexual abuse.

The reader is cautioned to always look for changes from the usual way a child behaves. Certainly this is not meant to be an exhaustive list, but from my years of experience, these are the dominant areas where changes will occur.

In closing, I feel very sorry for former coach Paterno but, of course, I feel sorrier for the children who were abused. What a shame, what a tragic shame!

I met Andy Rooney once—years ago at a book signing—and yes he did autograph my copy of his work. From what I could tell, he probably would hate having someone pay homage to him, but perhaps the way I plan to go about it would have made it a little more palatable:

- You ever wonder why kids feel the need to get high?

- You ever wonder why the economy is going through such difficulty when nothing has truly changed. I mean farmers are still growing crops, the world is still a dangerous place, the American spirit is still alive, but somehow everyone is looking for work. What changed?

- You ever wonder why people like to give you the finger when you drive to work in the morning–and why you let it bother you?

- You ever wonder why we have anti-Semitism and racism in the 21st century?

- You ever wonder what makes Facebook and Twitter so special?

- You ever wonder why it can snow on the East coast before Halloween and still people doubt climate change is occurring?

- You ever wonder why somebody thinks they are better then somebody else?

- You ever wonder why newscasters make so much out of so little?

- You ever wonder why entertainment shows get more airtime than the news?

- You ever wonder why electric cars are not already more dominant than internal combustion engines?

- You ever wonder why “fracking” is not illegal when it poisons the environment?

- You ever wonder why the folks we send to Washington–be they Republicans or Democrats—cannot simply compromise even when people are out of work and struggling to feed their families

Well, I will miss you, Mr. Rooney. You may have retired from “60 Minutes” several weeks back but I still felt better knowing you were alive!

Image courtesy Wikipedia Commons.

Herman Cain’s website ad featuring his adviser Mark Block looking like a “cool cat” taking a deep drag on a smoke and exhaling at the end of the commercial has received well over one million hits. This ad is unconscionable!

Cain claims that the commercial is not trying to make it look “…cool to smoke.” But when he was on “Face the Nation” Sunday, moderator Bob Schieffer gave him deserved hell. (Schieffer is a cigarette-related cancer survivor.)

What was Cain thinking? God help him if it comes out that he has received money from the tobacco lobby!

Some folks say Cain is being picked on because he is a conservative black man.

As an addiction specialist and father, as well as someone who had a father-in-law who died a young death from cigarette-related cancer, I assure you the negative reaction to Cain’s ad has nothing to do with party affiliation, skin color or philosophical perspective. This type of ad in this day and age is irresponsible and I say good for you Bob Schieffer, and shame on you Herman Cain and, as we are seeing this week, bad karma is following him.

A new study conducted by researchers at the University of Pittsburgh (Addiction, October, 2011) shows that the lyrics of many rap and hip hop songs promote a lifestyle that is lavish–replete with sex, drugs, violence and general partying. Perhaps most interesting are the references to brand names of alcohol.

Listening to 793 hit songs from 2005 to 2007, approximately 25 percent of the tunes mentioned alcohol-referenced specific brands. (For every one-hour’s worth of music, about 3.4 alcohol brands are mentioned; the average teenager listens to 2.5 hours of music a day). A strong association between alcohol and money, as well as alcohol and the use of other drugs, is made quite frequently.

We know that these types of associations lead to early-onset drug and alcohol abuse and addiction. What is so interesting is that the researchers note that the brand-name references are generally unsolicited by companies—the point being that the artists, composers, etc. are doing this on there own. Certainly that might give parents pause before they pay for their kids to go to another concert!

According to a number of federal agencies, vehicular accidents have become the major cause of death among teens in our country. This is simply unacceptable.

Here is what we know:

According to the Centers for Disease Control, those individuals between the ages of 16 to 19, are more likely to be seriously injured in a car accident or killed then from any other circumstance or disease.

Male youth have a greater tendency to be reckless and careless when it comes to driving.

In many instances, alcohol and other drugs play a role in these accidents and this age group seems to be more effected by consuming the same amount of alcohol as an adult when they drive. This might be related to inexperience (although obviously nobody should drink, or drug, and drive).

Seat belts are often not worn.

The perception of potential hazards are poor compared with more experienced drivers.

The more youngsters in a car, the greater the risk of accident—perhaps due to distraction or showing off.

Distractions such as speaking on cell phones, texting, fiddling with MP3 players or GPS systems, as well as eating or consuming beverages, is a tremendous issue.

There is a greater incidence of speeding and not paying attention to lights, stop signs and other types of signs such as those indicating mergers, etc.

Finally, there is the teenager's perception that hr or she is immortal. This, too, leads to greater risk taking.

So what can we do as parents during this National Teen Driver Safety Week?

Continue to support driver education programs.

Encourage "graduated" licenses until the teen gains more driver hours over time. (In other words, restricted licenses in the beginning such as having an adult in the car for certain situations, restrictions on evening driving, and restrictions on where a teen is permitted to drive.)

Promote awareness of the dangers of drinking and driving and doing other drugs. The best way for parents to set this in motion is to set a good example and not drink and drive themselves.

When we have the ability to protect our youth from needlessly being injured or dying we must do everything in our power to exercise it. Anything short of taking proper measures raises angst in all of us—and so it should!

I have specifically treated folks who have worked on The Street for more than 25 years. When people come to me they are usually very unhappy, unfulfilled, even scared and in emotional angst. They feel completely stressed out and worry about keeping their jobs. Will they meet their goals, get their bonuses so they can pay back their credit lines and continue to pay their mortgage? Will they be able to stop acting out with drugs, alcohol, sex, over-eating—self-medicating their fears as they discover they have developed a full-blown addiction?

Isn't it ironic that we have tremendous protest over Wall St. and yet many of those who are the workers on The Street—and are perceived as "having it all"—find it ego-dystonic (which refers to feelings that are in conflict with one's self-image).

I cannot tell you how many times my financial patients have needed to go to inpatient rehab but were afraid that they would lose their job if they were away for 28 or 31 days. Sad but true. That was one of the driving forces behind my involvement in creating two inpatient rehab programs—one at Cornell Westchester and one at Mount Sinai, that had average lengths of stay of a week to 10 days.

Any Treatment Is Better Than None
Some of my colleagues criticized shortening the average length of stay. But my argument under my model of "carefrontation" was any treatment is better then no treatment. If inpatient rehab is the proper level of care, we must design programs that meet the patient where they are at—not where we are at in terms of our philosophy. Change is good, and for some populations of individuals it is necessary. Now don't get me wrong, 28 and 31 days is always the best model (or even longer), but for some it is impossible and they have a right to treatment as well.

Back to the protests. Our country's economy is in shambles. I don't care which administration caused it, the point is, it is horrific. People are out of work, losing their homes. Families are breaking up. Children are scared. Our young folks are going to college and have poor prospects for employment afterwards, with school loans hanging over their heads. But the irony is that the relatively few who work on Wall St. are also suffering in their own way.

I am aware that having a job is better then not having a job. There is no comparison and working on Wall St., even if the pressure contributes, in some cases, to addiction, is "better" then not having money to feed or clothe your children. But philosophically it is ironic that the economy—this artificial entity—has caused so much suffering all around.

Life is a puzzle—a mystery made up of rises and falls, of twists and turns, of "haves" and "have-nots." It saddens me that our children, for the first time in this country, will perhaps achieve less then their parents did. Yes, even the Wall-Streeters' kids.

Life is painful at times, but I believe that there is a reason we are all going through this crap. And if the protesters can wake us up (particularly the leaders of Wall St., the heads of banks, as well as our government), I say God bless them!

37 percent of people with anxiety disorders abuse substances–particularly alcohol and benzodiazapines *

I find the statistics fascinating and admit they are probably underestimated and have grown over the past three years. Yet many treatment facilities–both outpatient and inpatient–are still focused on treating one or the other instead of truly focusing on integrated treatment. They rely on serial and parallel forms of therapy–for example, they focus on the alcohol and drugs then go onto the mental health issues, or vice versa. Or they have the patient go to two agencies at the same time.

I am not talking about all facilities (indeed, I work for one that “gets it”), but many places across the country need more training in one specialty or the other–or both! I know this is shocking; we have made improvements, but still have a ways to go.

I see myself as someone who works with the whole individual. I have trained extensively to understand psychiatric illness, abuse and addiction, and the delicate interplay between them. It has led me on a journey that makes me really try to not become frustrated but, rather, understanding. It makes me feel like the old TV detective Columbo–“ah…just one more thing” was his technique for eliciting deeper understanding.

I love asking questions–trying to derive an understanding of the genetic factors, the life experiences and the influence of the zeitgeist on my patients.

Gertrude explained to me that you have to understand the whole dog and not just get caught up with focusing on one aspect of the creature.

Today, my wife and I went to a “Blessing of the Dogs,” an event held yearly in Branford, Conn., on the town green. We go there on weekends to unwind – breathe in the salt air and actually remember we are on this earth but a relatively short amount of time.

Gertrude, our English Bulldog, was such a good psychologist. I’m not sure she understood the priest’s blessing, but she found out so much about her fellow dogs. She sniffed, jumped, rolled, licked, scratched and simply looked around. Between you and me, she noticed that some of her friends were not all that well adjusted. Some were neurotic and medicated themselves with overeating (I could identify with that one), biting themselves, scratching themselves incessantly, licking themselves in ways that could only be described as deviant, being passive, being aggressive, etc.

Gertrude explained to me that you have to understand the whole dog and not just get caught up with focusing on one aspect of the creature because, as she said, “you miss something that can be an important clue in treating the pooch.”

“For example,” she continued, “if you just say, ‘aggressive’ Rottweiler, and leave it at that, you might miss another problem like excessive water consumption, which results in excessive urinating, and therefore discipline, which makes the dog aggressive.” Gert said it could lead to a “Catch-22” phenomenon. She is so smart!

We met one pup by the name of Sheldon Kornpett–named after the dentist played by Alan Arkin in the original version of “The In-Laws.” Turns out the master was a dentist and thus the influence of the zeitgeist on the animal.

Please, fellow clinicians, take a page out of Gertrude’s playbook and study the whole person. I never knew our profession was going to the dogs, but perhaps we are better for it. Sorry, no angst this week; maybe I should continue consuming biscuits!

I am considered to be one of the top folks in my field of co-occurring disorders—treating people with chemical addiction and psychiatric issues. I didn’t say this, but those who have written about my work have, such as the Castle Connolly Almanac, which rates individuals in the medically related sciences.

I know that there are people out there who think I have an ego the size of a small country and, to be honest, at times that hurts me. Yet perhaps it goes with the territory. If you have your own views on things, and you are willing to take other “experts” on, you simply get tagged with this kind of thing.

I know that my patients have 24-hour/7-day-a-week access to me, and that I often am willing to go above-and-beyond for people. I also know that I am very involved invarious charitable organizations, and love to help young people straighten out their lives and understand what they want to do on their journey. I understand that it should not matter what others think and, for the most part, I truly don’t.

But again, why is it so easy for folks to put down what they don’t understand?

I have been called a name-dropper at times and the sad thing is I really don’t drop names—I just share about people in my personal life who have influenced me. Not patients, of course, just people in my life.

Many were my father’s clients (he was a CPA in the entertainment field). Also, my godfather was John Birks (Dizzy) Gillespie, and he had a tremendous influence on me—including influencing my approach to therapy called “carefrontation.” Just because he was famous is not my fault. Just because I have had a radio program for 24 years, or I do a great deal of national television, is not my fault. It is my world, and I don’t like being branded arrogant, egotistical, a name-dropper, brash, a “know it all”—well, you get the picture.

Those who take the time to get to know me, will I hope, tell you that I am a good guy and would give you the shirt off my back. We are all human and I just wanted folks to know that “you can’t judge a book by its cover” applies to even “doctors.”

Hopefully, what I am saying here will be understood and not just feed things more, but be seen as a “caring, honest share.”

Let me begin this piece by saying I am about to give some advice that has taken me years to accept myself: Feel your feelings.

This thought ironically occurred to this clinician when a patient of mine told me that he was feeling down because someone he was involved with broke up with him and he felt sad. Well, I thought, of course he should be feeling sad.

We have become a nation—perhaps a world—where we actually believe we should not feel our feelings. I have so much training as a doctor of psychology, but that does not mean that I am not still just as human as the next person and, at times, have gotten away from feeling my feelings. I mean, shouldn’t one feel sad if someone he cares about and is involved in a relationship with breaks up with him?

WeNeed To Work Through Our Feelings
We are always looking for something to make us feel better. On some level, that’s logical, but we need to work through our feelings and not simply turn to a drink or a drug (licit or illicit) to change the way we feel. That is like wearing a mask over your face because you don’t want to deal with a scar. You must deal with the scar.

Dealing with the scar is what helps you to feel better; not just to “mask” it. Dealing with your feelings gives true meaning to your life. William James, the father of modern psychology, once made reference to something Socrates had said several thousand years prior: “The unexamined life is not worth living.” This does not imply that, at times, individuals may not need professionally prescribed medications to help them to feel better. But simply taking a pill is just not the solution.

I first commented on the “instant fix” phenomenon as something that was endemic to the “microwave generation” years ago at a town hall meeting of private schools in Manhattan, and I have written about it many times since. The “microwave generation” is something that we certainly see among baby boomers and “boomer juniors” who “want what they want when they want it.” It is the id-oriented need for instant gratification and it is destroying, at the very least, American society, in this author’s humble opinion.

Think of the vast number of commercials on television that promise instant relief for the latest ailment. Perhaps Viagra is the greatest example. Now don’t get me wrong, many medications are wonderful for dealing with medical issues. But let us say you take a pill for impotence due to Type II diabetes. Shouldn’t you still do the work to deal with the diabetes—diet, exercise, test your blood sugar. You get the point.

What has always made me proud to be a psychologist is helping folks work through their issues. This did not mean that I turned my back on science (after all, I co-authored the PDR Drug Guide to Pediatric & Adolescent Mental Health Professionals, 2008), but I always knew that my patients needed more than just a pill. I always knew that my alcoholic patients would return to the bottle if they did not have some insight; if they did not have the cognitive awareness of their thoughts relative to their actions before they picked up that first drink.

Don't Look for the Quick Fix
Feel your feelings, my friends. Don’t run away from them and simply look for the quick fix because, if you do, your life will not stand for anything. Your life will be all about the easy way out, like college students who pay someone else to write their papers. You must do the work; you must try to understand the lessons that life tries to teach us so that someday you can say you became a tad more self-actualized over time.

If we don’t try to feel our feelings and learn what they mean and where they come from, then at the end—at the stage Erik Erickson refers to as “ego integrity vs. despair”—we will be human vessels filled with nothing more then angst!

As I reflected on the tenth anniversary of September 11—having lost a cousin in Tower II, and having worked for over a year, when I was with NewYork-Presbyterian Hospital/Cornell Medical Center Westchester, with first responders who were drinking and drugging to medicate their post traumatic stress—I thought about the fact that our country has forever changed. I know this has become a cliché, but it is a cliché because it is a fact!

I received a “Service Excellence Award” from Cornell for my work, but I am sad to say that all it does is remind me of how torn and confused I was at the time. The myriad pills, alcohol, inhalants, etc. that were consumed by folks who were so scared—no that

I speak my feelings here, and those feelings are not always the rational “doctor” part of me.

is not even the right word—more like tormented, stunned, beleaguered, lost, confused, despondent, hopeless—confused this psychologist and addiction specialist. It made me say to myself, “Why wouldn’t anyone simply want to get high if they could even reach high or just numb.”

I am an honest man. I speak my feelings here, and those feelings are not always the rational “doctor” part of me. I want you to know that; I owe it to you to relate that I hate the disease of addiction, or just abuse, but September 11was different. For the first time, I understood why people needed to escape and clutched on to anything that would take them away from themselves.

I hope you can all understand what I am saying here. Again, it confused and frightened me. It made me question myself; it caused me great pain and was a time in my career I shall never forget. It was what it was; it is what it is; I am what I have become this day forward. And perhaps in some weird way—very weird and strange—it made me a better psychologist!

When I was a little boy—oh, about the age of 7, I started having a recurring dream, and now in my 50s I just had the most recent one.

In reality, my parents had a very old cabinet/chest in the garage—the garage was attached to the cellar, and was damp, dank, dark and, well, spooky. Indeed, this pale yellow cabinet/chest was the only bright thing about it.

Well in my dream, I open the doors and enter the cabinet—kind of an Alice- Through-the-Looking-Glass-like theme. As I enter the cabinet/chest, I am on a dirt road and on both sides are huge apple trees with large red and green apples as large as small pumpkins. I walk down the road and I come upon a farm. I notice that the air is sweet and cool—but not too cool—and realize that it is like a combination of fall and spring.”

Well I come upon a farm and there is an ice cream stand constructed of wood. An old lady asks me what flavor I want. She looks like Helen Hayes—hair in a bun and a sweet smile. Her body is slender and she is weathered from the sun. She is wearing a basic dress replete with an apron that is part of the dress in a way that makes it seem as if it is painted on the dress.

She says, “Young lad, what flavor would you like?” I am afraid to ask what flavors she

She says, “Harris I know you don’t have money but I never asked you for money.” How does she know my name?

has because it almost seems to be an imposition. Instead I tell her whatever she thinks, and she begins to scoop what looks like peach ice cream from a wooden case with a door that lifts on the top. She scoops these large balls of ice cream that seem as big as the apples I saw on the trees into a sugar cone, and hands it to me. I tell her I don’t have any money. She says, “Harris I know you don’t have money but I never asked you for money.” How does she know my name? But I feel I should not ask her, so I take the cone and taste it with delight.

In reality, I am not a fan of peaches, but this ice cream is made of sweet cream and fresh peaches—not syrupy, mushed pieces out of a can. I can eat it with my mouth, eyes and sense of smell. It is so fragrant, and it adds to my sense of well-being. “Sweetheart,” she says, “you better get going before the sun sets.” I turn from her and begin the trip back through the doors of the chest. As soon as I go through the other side, the ice cream is gone. I awaken.

I have analyzed this dream with the best of them and quite frankly I have no intention of sharing the latent meaning in my life of the manifest presentation. It is personal and I just don’t want to share it right now—perhaps someday!

However, I did want to share the dream, because it has always been so refreshing and life affirming to me from the age of 7 all the way up to my 50s. Whenever I awaken after having this dream, I always know I will be okay. My life will be whatever I want it to be; whatever I choose to make it.

I believe each one of us has our own safe place where we renew our soul—whether in waking life or asleep. After this dream, I don’t care what others think about me. I feel empowered to speak my mind but have no real need to because I know that it is enough for me to know my truth. Find your dream!

It is now Sunday evening and the rain is pouring on the roof of my Westchester, N.Y., home. The flat roof intensifies the rain with each drop and I cannot sleep. Something upset me so much today that I am now only able to wrap my head around it; I am choked in my throat.

I went to visit a friend this afternoon in Bedford to talk about some things that I have had to deal with lately and, as I drove on Route 172, I suddenly noticed a huge boxturtle crossing the road. It was as if life stopped. I pulled over and signaled the oncoming traffic to stop so I could hasten it along, but it was no use. The cars seemed more interested in speeding to their rainy-day destinations.

Sure enough, one of them ignored my gesturing hands completely and ran over it – its shell cracking into pieces as tears streamed down my face and mixed with the rain. How ironic, I thought to myself, they were driving a Prius—so conscious of the environment—yeah, real f*#ing conscious!

Trust me, I was practically standing in the middle of Route 172 and they saw me urging them to stop. And the turtle was so large they had to at least think perhaps it would hurt their precious environmentally friendly car if they ran over it.

Its struggle to get to the other side of the road reminded me of a documentary which I probably had no business seeing as a kid—“Mondo Cane” (Italian for “Dog World”) where, in one scene, all of these turtles lay eggs in the sand and die in their struggle to get back to the sea.

Look, I can’t even think about this logically in any way and I am pissed and you want to talk about angst and sickness in my heart—and the obligatory struggle of believing in God!

Recently, life has been handing me some very interesting, disturbing and rather grown-up lessons – and by the way, how the hell did I land in my 50s, and why do people get sick, and why do politicians screw with people’s lives, and what the hell is a Michele Bachmann, and why doesn’t Obama at least try a little harder to help the working poor instead of just promising to, and on and on and on. Oh yeah, and why did a turtle have to die?

Don’t look for some lesson in this week’s blog because the only one I have come up with is “sometimes life sucks!”

Therapy really does work–that has been demonstrated time and time again in study after study. It is both a science and an art, however.

The science has been researched for many, many years and has led to developing techniques (for lack of a better term) that moves the individual ahead. Regardless of whether it is cognitive, behavioral, psychoanalytic, existential, gestalt or that great word “eclectic,” the goal is for the patient to feel better. Insight, behavioral change, cognitive restructuring are all designed to take an individual from point “A” and move them to point “B.”

But it is the artistic aspect that I have always fascinated me. As a psychologist, I spent years studying psychology–understanding the intricacies of each approach, doing research, designing my own research, taking practicums on individual therapy, as well as practicums on group therapy. So many years and years of studying the science of psychology, followed by a published dissertation, then a year of post-doctoral study, and then taking a licensing examination that was quite challenging. I didn’t even mention all the years spent studying statistics and brain science to understand the intricate detail of neuroscience. But again, I was always most interested in the art of presentation and process.

Perhaps I can use music to better explain my fascination with the artistic aspect. Whenstudying music, I had to read music; learn how to play an instrument—in my case, the fingering of the tenor saxophone and the tone—as well as the clarinet; how to play alone and with others (in groups); years of practicing scales and understanding music theory. I then went on to jazz and learned how to improvise—go off the music sheet and start to create spontaneously. There, for me, is the art.

Admittedly, this is my own opinion. I love creating jazz – being mindful of intricate riffs that must still stay within a key signature and harmonize with my fellow musicians, all to a specific beat.

Giving Psychology Away
I had a psychology professor in graduate school, Dr. John Smith, who said it was important to “give psychology away.” I thought to myself, when you play jazz you give the music away because it is spontaneous, from the gut. You need to know all the basics–all the “schools” of the music and intricacies of the instrument–of course, but then from your insides you create something that connects with others on such a deep level.

When I meet with each patient that is what I try to do.

I try to “give psychology away.” I share, I explain, I am vulnerable, I am silent, I am available. But there are times I have to be less available and let the patients take the tools and try to build for themselves. It is a very hard thing to do and sometimes very frightening and can be lonely–but I love “giving psychology away.” That is what “carefrontation” is all about–no shaming, no blaming–just helping the patient to take responsibility for dealing with his or her illness. (I say illness here because I primarily deal with psychiatric illness and addiction.)

I Don't Ever Dismiss a Patient's Feelings
I am the first to admit I am human. Sometimes patients don’t like my “artistic style,” which is very client-centered yet honest; very sharing and well-caring, but very direct. To me it is the “jazz” of psychology. I am not afraid to let people know what I see going on with them, but I want to know what they think is going on with them and don’t EVER dismiss their opinions and chalk them up to their being “crazy” or an “addict.”

I make sure that my patients know we are all human, and that particularly includes me! This can raise defensiveness and make folks run for the hills, but I am so grateful that, for most, it authentically engages them while maintaining professional boundaries.

I consider myself extremely ethical as I attempt to harmonize with the patient. I use things in my office and outside my office to raise topics—this can be anything from pictures to music to art to current politics, a movie, television program, or well simply the weather. While I am trained to understand, and be extremely sensitive to, transference and countertransference, I don’t just look at these constructs but I discuss them. Knowing what a patient can kick up in a therapist is very informative to the process.

So, to this clinician, therapy is a science and an art. It must always be evidenced-based—in treatment, outcome often defines this. I love the work I do and the jazz and harmonies I create with my patients. I would say to any of my students (including my medical fellows) that you must understand the theories and models of psychology inside and out before you can learn how to play a “melody” that has meaning to a patient—and one that they are not afraid to hear!

I promise this is not a political blog–I don’t give a rat’s keister about politics, but I do care about human beings and what all of our leaders–on both sides of the aisle (or independent of the aisle), do for the folks they supposedly represent!

Ever hear a baby cry from hunger, or see the humiliation of an adult looking for work as they lose their home despite the fact that, prior to being laid off, they always paid their mortgage on time?

I am filled with angst as well as disgust at the economic shape of our country. If I hear

Our leaders have a disease. It’s primary, progressive and seems to be chronic.

one more person say America’s best times are behind it, I will blow a gasket! In a country where compromise was the cornerstone of the constitution, shouldn’t our alleged leaders take a chapter out of our forefather’s playbook?

“moderates” (now there is an ironic term), have got to get their act together and take a look at Main Street. Look at the neighborhoods that are crumbling, the overgrown lawns that are the tell-tale sign that a family has moved out and abandoned their home, the inability to pay for healthcare, the 401-ks being cashed in, the college tuition simply not affordable, the mom-and-pop shops that are closing, the large chain stores that are closing, and on and on and on!

This crap has to stop, and it all comes down to one word: Compromise. You give a little; I give a little and you help your constituents to live another day. To be able to see their doctor or dentist, to get the medication they need, to put a roof over their heads—maybe even be able to send their kids to college, save for their old age. Or, can you even imagine it, have faith in the greatest country there ever was, whose best days are ahead of it—a country that always cared about people, a country where sooner or later, through compromise, consistently saw more reasonable minds prevail.

You have seen me make a pretty good bio-psycho-social argument in other posts for the fact that addiction is a disease—primary, progressive, chronic, and if not treated fatal. Well here is another newsflash folks: Our leaders have a disease. It’s primary, progressive and seems to be chronic. But the ones who are dying are the people they represent. America, this has to stop.

To turn Amy Winehouse’s death into a “cult mystery” of the “Tragic 27 Club,” joining the ranks of other drug-related rockers’ deaths including Janice Joplin, Brian Jones, Jimi Hendrix, Kurt Cobain and Jim Morrison, all music legends who died at the age of 27, is to deflect from the importance of young, talented musicians who were plagued by the disease of addiction.

Psychologically speaking, it is not that unusual that people like to divert attention to something else—human angst leads folks to look for what social psychologists often refer to as “causal attribution.” Fritz Heider, who is considered the father of Attribution Theory, discussed that people like to make sense out of things—even if the process goes beyond mere sensory input. We human beings like to look for what might be “logical” commonalities, and need to have nice, neat packages to wrap everything together–even turn them into mysterious “death clubs” that distort such talented lives into “Tragic 27 Club.”

Here’s a theory—creative rockers are immersed in a life of “drugs, sex, and rock ‘n roll.” Many of these individuals have an addictive disease that is primary, progressive, chronic, and if not treated fatal—but many do not!

Amy Winehouse died in 2011. Joplin, for example, died in 1970. Should we focus on the reality that these events were 41 years apart? Should we see how different thetimes were for rockers in the 1960’s compared with Winehouse, who hit her stride in a completely different century? Should we instead accept that 41 years later people are still dying from the disease of addiction? Should we ask ourselves how many artists died from addiction at ages other then 27? (Did we ever hear of Charlie Parker, Judy Garland, Elvis Presley, or Michael Jackson, just to name a few, who were all different ages and died from alcohol and drug-related issues?)

Instead, we focus on coincidence of age. You want to look at reality, look at people who start out in a profession quite young and are pushed and prodded to get hit after hit and tour night after night, and who have the disease of addiction that is enabled by some of those around them. Then the public tries to make sense out of it and turn the tragedies into perceived “mysteries of death”—the demonic Thanatos, the Greek embodiment of death, that great unknown that calls to us.

Let's stop looking for odd coincidences to turn people’s tragic deaths into a “club” instead of a disease that kills, and needs to be understood biologically, psychologically and socially. I truly say this out of almost 34 years of working to understand this horrible disease and treat all of those who fall victim to it with caring and respect. Thank you for listening.

Image courtesy of Wikipedia Commons.

Is anyone out there besides me old enough to remember The Loving Spoonful? They had many hits, but the one I am focused on is [What a day for a] “Daydream.” One line is: “I’m blowin’ the day to take a walk in the sun/And fall on my face on somebody's new-mowed lawn.” Perhaps back then that was a drug reference, but I choose to interpret it as getting in touch with the child within me.

I have always loved the smell of freshly cut grass—that sweet, intoxicating scent under a blue sky and warm sun that screams for lemonade and a dip in the ocean. And speaking of the ocean, the briny smell of the sea air—oh now that is a true high!

My childhood in the summer was filled with ringoleavio, stickball, body surfing, cookouts, ice cream, camping in our backyard, S’mores, roasting marshmallows over a campfire, telling ghost stories, excitement over fireworks on the Fourth of July, bike riding, outdoor concerts, and sleep-filled nights from exhaustion, as the air cooled and came in through my window.

I still love all of those things but the ”new-mowed lawn” could have deer ticks, the sun could cause melanoma, and ringoleavio, stickball and body surfing could be dangerous. You could get accused of grabbing someone inappropriately in ringalevio, break a window and be sued playing stickball and, well, as far as body surfing goes, let’s not even fathom red tide! Camping in the backyard could result in someone being bit by West Nile Virus-carrying mosquitoes, S’mores and marshmallows could put your glucose over the top (not to mention the potential burn from the campfire), the ghoststories could kick up PTSD, the fireworks could blow out an eardrum or perhaps result in visual floaters, bike riding could cause prostate issues for boys later in life from the seats (and assorted other injuries) and outdoor concerts could certainly cause hearing loss. Not to mention that sleeping with your window open could lead to kidnapping!

Don’t you just love modern life? I say throw all caution to the wind and go for a walk. Okay, maybe wear a beekeeper's suit!

I can only imagine how many blogs are being written on Betty Ford. Yet I felt I still had to discuss her as well.

I cannot remember when I was asked to speak at the Betty Ford Center on co-occurring disorders. Perhaps it was 1995. In any case, I remember how nervous I was.

You cannot believe that you will be popular speaking about how many people with addiction issues also had undiagnosed psychiatric illness. Back then this phenomenon was still referred to as MICA (Mentally Ill Chemical Abuse).

As I addressed over 150 individuals—professionals and patients—I remember that I wished I had a Valium. That's how uptight and filled with angst I was!

I don't remember how it went because after my talk I was introduced to a special person who attended, Betty Ford. She simply said something like, "Thank you for helping us to continue to better understand this disease."

I had been to the White House for a weekend in 1990 when my godfather, Dizzy Gillespie, received the Kennedy Center Medal, but having someone like Betty Ford receive my talk positively trumped that weekend!

Forget that this hero (she would have resented heroine, as a staunch feminist), had the guts to reveal that she had breast cancer at a time when we would never dream of such a discussion from a first lady, or any women. Or that she was an alcoholic and iatrogenic addict and needed help for the DISEASE as well. Betty Ford had the chutzpah, the guts, the gall, the unmitigated "audacity" to be a "housewife" from Grand Rapids, Michigan, who was married to an extremely conservative Republican, and come out for the Equal Rights Amendment when the "President" was against it, support Roe v Wade, discuss premarital sex using her daughter as the vehicle for the discussion, and the list goes on and on.

Betty Ford will be remembered for the Center in Rancho Mirage, California—and that's great—but this modern-day Eleanor Roosevelt, this woman who, like Ghand,i was truly self-actualized, should be remembered for moving America into a caring, thoughtful place. Now that's a hero!

“Aging is not for the faint of heart, my dear boy,” my dear mom told me towards the end of her life. At the time, I intellectually understood her statement, but I did not relate to it in my soul. Now that I have begun to explore my 50s, with the accompanying aches and pains—and the existential angst that aging brings—I more than feel it in my gut!

We all hear that 50 is the new 40, but trust me it is 50. It is mid-life if you live to be 100, and even though we see tremendous advances in medicine—and indeed, people are living to older and older ages—I don’t think they are doing the same things at 90 that they did at, say, 45. Someday I am sure they will, but I don’t believe it will come in my lifetime.

It Gets Better
As I write, I admit I am annoying even myself by sounding like such a pessimist. But if you continue reading, you’ll see this is actually a very optimistic and uplifting piece.
I believe we have to embrace the journey. Don’t be so disgusted that you might not be able to run as fast or jump as high (yes, I know some of you still can). For the most part, notice that you probably could not think as clearly at 20 (yes, I know you can develop dementia, but the majority of people don’t).

You see, aging brings change, but the change is also quite “building.” I see things so much clearer now and have a maturity that allows me to deal with what lies ahead that I never had before. No, I am not able to do one-and-a-half back flips on the trampoline, which I could do when I was on my high school gymnastics team, but my writing is crisper, my lovemaking more tender, my appreciating the sea more acute, my gardening more defined, my driving skills more well-rounded, my speeches more engaging, my sensitivity to patients fuller, my understanding with my daughter much more patient, my gentleness with my dog more acute, my wisdom in general more complete.

There's More Time To Reconsider
Some would say that these statements sound narcissistic and arrogant, but as one gets older you can learn to accept what others say if you truly know what it is you mean in your own heart. What you mean becomes more important; what you mean becomes more sincere. There is always time to explain what it is you mean—you are more willing to give people a chance to reconsider, and you are more willing to reconsider yourself.

Several years back, Clint Eastwood did a brilliant movie, “Unforgiven.” Suddenly the fear behind the violence was present. The thought put into killing a man was present. The anger came from the root of existence. The indignation was righteous. The blood was redder. The need to live sober, regardless of the outcome, was understood. The faces were more weathered than made up. The pain was present. The respect for the “act” was simple and deliberate.

I just read Michael Sokolove’s recent article about Derek Jeter in the New York Times Magazine.He makes the point that we don’t like to see our athletes age. Well, Derek is a young man by anyone’s standards except that he is in a profession where time takes its toll earlier. He is still a brilliant ballplayer and, besides closing in on 3000 hits, he gives the Yankees’ organization everything they stand for. Through Jeter, we can see that age is relative! Generals tend to be older and wiser; foot soldiers younger and filled with more stamina.

It's All About the Journey
Age is quite complicated. It is a multivariate issue that is very much dependent on what you are looking at in order to define its essence. With age, you either improve like a fine wine or you become withered like a rose. Stop trying to figure it all out. Focus on the journey. The journey for me is the whole secret to life; the entire ball of wax. The end does not justify the means. The means is ongoing right through the end—indeed, the end is simply more life—whether you believe in the hereafter or you understand that if you focus on the journey you will live on through your deeds.

I remember Mantle, Joe Louis, Jack Kennedy, Hemingway, Kerouac, Miles Davis, Hitchcock, Brando, Hepburn, etc. They are not among the living, but their acts during their respective lives keep their memories burning in my brain. I wish we could stop looking at people’s ages. Let me think of something brilliant and psychologically insightful here to end on–oh yeah, it’s stupid. Have a nice day!

The only thing that upsets me more then seeing a patient or family member suffering is to see a patient or family member who admits they do indeed have an issue but he or she is not willing to take responsibility for it. Responsibility is something I discuss a great deal in my blogs–being accountable, which is such an important theme in recovery. One must come to know that recovery is always made easier if the individual feels that he or she is part of the human condition. This is not that different than any individual feeling a sense of connection with the human condition.

Our society is filled with more fear and frustration then ever before, in this clinician’s humble opinion. People seem lost for answers and are more isolated from society atlarge. We need to get back in touch with what connects us as human beings–often we define ourselves by others. Although we need to develop our own sense of identity, we still need to have human contact–without it there can be no accountability to ourselves because we are, indeed, part of a greater universe.

As John Donne (1572-1632) wrote:

"All mankind is of one author, and is one volume; when one man dies, one chapter is not torn out of the book, but translated into a better language; and every chapter must be so translated...As therefore the bell that rings to a sermon, calls not upon the preacher only, but upon the congregation to come: so this bell calls us all: but how much more me, who am brought so near the door by this sickness....No man is an island, entire of itself...any man's death diminishes me, because I am involved in mankind; and therefore never send to know for whom the bell tolls; it tolls for thee."

And so we all need each other. But lately it seems like something is up in the world and we have forgotten this important “humankind” lesson. We need to return to the knowledge that nothing—cell phone conversations, texting or any other technology—can take the place of people-to-people contact.

I have always said to my patients that the most important thing they can do in the service of treating their addiction is to realize that they want to stop a drink or a drug because they want to be a better person for themselves, their family, their friends and society. It is this very vital connection to society that I am stressing here. Be your own person but know that you are part of man/womankind. Trust me, it works!

I attended my second cousin's Orthodox Jewish wedding this past Sunday. It was a lavish affair with so much food and festivities that it could have been turned into an episode of "No Reservations."

I could see it now, Anthony Bourdain arrives and samples the kishka (a dish made fromflour and fat wrapped in cow's intestine). He then makes his way to the smoked fish display, with the lox spread shaped into a goldfish. The caviar flows along with the Champagne and vodka, and a myriad number of other delicacies are served including thick slices of brisket, corned beef, pastrami, smoked turkey, and tongue with raisin sauce on slices of rye and pumpernickel (and this was just a little cocktail party before the ceremony!)

Well that is the manifest story. But the latent story—the hidden plot if you will—is my first cousin, who continues to deal with a life-robbing disease that crushes one's heart and soul and makes one weep. He is the bride's uncle, and one of the bravest men I have ever met. I also notice his mother, my dearest aunt, is not at her granddaughter's wedding—gone a year and a half before and only in her early 70s. I look around the synagogue and see so many uncles who were once so strong now in their 80s—still amazing but in a quieter way.

The bride is beautiful in a lovely traditional gown that made her look like a Jewish
Princess, but the real princess—the kind you find at Buckingham Palace.

As the ceremony begins, my cousin, who finally came out about being gay, relates three or four jokes that are funny yet biting. I can smell the strong essence of camphor on the clothes of the man sitting in the row in front of me. His suit probably was stored for the winter. No moth holes, but perhaps he would have been more attractive if his suit smelled less and had a few moth holes. As the rabbi begins, several cell phones go off despite the fact that a request went out to shut them off. They mostly belong to young people who simply cannot be "out of touch" even during an occasion in a house of worship!

When the ceremony is completed, the reception gets under way. And so a step in the development of another nuclear family begins, and all is right in the world as the music is cued and the men dance with men and the women dance with the women (given the orthodox religiosity of the event). Each group raises the bride and groom high up in the air on chairs, and all kinds of swirling and twirling takes place to folk music that is archetypal.

Life is a wonderful thing filled with dynamic tension—a wedding of two lovers against a backdrop of pain. But for five hours all was a fairytale with no angst.

Many years ago I came up with the concept of carefrontation. Simply stated, carefrontation is a treatment approach for addicted individuals and people with co-occurring disorders that advocates for treating every patient with respect and dignity–no shaming or blaming–but does hold people responsible for dealing with their issues.

Carefrontation was in direct response to more confrontative approaches that were developed to break through people’s defenses by challenging them in a strong manner in the hopes that one can get the person to hear what they are saying, and help develop insight and take responsibility for their particular illness. The problem is that when one confronts it usually results in making the person more defensive, which is an ego-dystonic process and usually results in their wanting to act out even more!

As a psychologist, my concept of carefrontation is based upon two key “ingredients”–firstly, motivational interviewing (a process of building on the patient’sintrinsic motivation by understanding their respective stage of readiness to change (Prochaska, 1987) and, secondly, health attribution locus of control (recognizing what the individual’s belief system is based upon–internal beliefs or external beliefs, which are further broken down into belief in powerful others and fate (Achterberg and Lawlis, 1994).

I find that carefrontation leads to a greater level of success that is more lasting (as evidenced by my patient’s progress over 32 years in practice, and a major study that I conducted and published (Stratyner, 1997).

The Model Is Extremely Client-Centered
There really is nothing that earth-shattering about carefrontation. Like Rogers’ “unconditional positive regard,” it is extremely “client-centered” and holds to a standard of treatment that practices the first rule of all good psychology–parsimony, or "pluralitas non est ponenda sine necessitate” (basically “entities should not be multiplied unnecessarily”; see “Occam’s razor”).

When folks are suffering with addiction or addiction and psychiatric illness, it is not logical to intensify their feelings with what I’ve previously referred to as “in-your-face therapy” (Stratyner, 2008). Instead, meet the patient where he or she is at! This is very similar to 12-step programs that talk about an individual’s “desire” to stop a behavior. Of course, an alcoholic or addicted person must ultimately stop the ingestion of mood-altering, addictive substances completely. We know if they don’t that their brains will continue the process of active addiction. But when they come to your office you don’t want to “threaten” an already fragile ego state and have them disengage.

The informed clinician, as well as the interventionist, know this only too well and invite the patient to change. As the therapeutic relationship develops, trust builds in a very rapid period (indeed, that is why a well-constructed intervention is so effective). This is especially true when working with individuals whohave psychiatric co-morbid states, and have extremely low levels of frustration tolerance.

So what have I learned thus far on this journey called life? At 56, I have discovered that I still feel the same as I always have—meaning the saying "young at heart" makes a great deal of sense to me now!

I have learned that some people never get it and some people do, but most of the time we don't even understand what "it" is!

I have learned that while it is nice to have a few bucks in your pocket, the saying "money does not buy happiness" is absolutely true!

I have learned that we should all be nice to each other and that nobody is beyond forgiving somebody. And I mean nobody!

I have learned that music is a gift from God, as are dogs, the ocean, the sky, books, ice cream, orgasm, baseball and, especially, laughter. Man, especially laughter!

I have learned that the love of one's children, no matter how old they are, is to me a natural event and I suppose when it isn't one should indeed have their head examined!

I have learned that to be a little famous is cool because you get dinner reservations easier but beyond that it is the same as not being a little famous!

I have learned that having a "Dr." Before your name wears off within the first week!

I have learned how smart my parents were!

I have learned that some people are miserable and that they have worked hard for that privilege and we should leave them alone if they truly want to stay that way!

I have learned that race and religion are just an excuse to hate and I am sick of the hating!

Lastly, I have learned that nobody is perfect and a psychologist's job is helping people to realize and accept that it is perfectly okay and probably right!

I love to see people fish, watch them discover great finds that are auctioned off for big bucks or observe folks surviving in the wild (when they don’t kill innocent animals just to make a television show and could certainly grab some food from the crew), etc. But why display celebrities whose careers have gone to hell as they struggle to get sober? Or folks with morbid obesity attempt to lose weight? Or those who want to stop compulsive hoarding, or any other voyeuristic journey into the lives of individuals who are trying to cope with life on life’s terms?

I know it helps to model healthy behaviors for others. But that is simply not what these shows are about. In my opinion, these are cheap ways to make television that sells commercials while the public is drawn to them like moths to a flame. They appeal to our baser instincts.

If television is going to “teach” and “model” positive behaviors, then education really needs to be done sans spectacles of detoxing human beings, exercising individuals who are struggling to breath, and exploiting those who have turned their homes into warehouses.

As a clinician, I am about treating people with respect and dignity. Take away the
reality television aspect of these shows and discuss treatment alternatives. Explain the disease of addiction or various forms of mental illness. Interview individuals about their struggles. Why you could even show a mock group or individual therapy session.

Depending on how you look at what causes you a crisis of existence, you will find social media comforting or discomforting. If you see Facebook, LinkedIn, Twitter, etc., as a way to stay connected to humanity then I would guess you would be comforted by these forms of social media. If you see these technological forms of staying in touch as isolating–in the sense of removing you from direct “live” contact, then social media might frighten you.

I think some of this is complicated by our age and what we have grown up with–I did not grow up with these outlets and on a Saturday night if I didn’t have a date or friends to help define me–I believe I would have loved these outlets. Today’s youngsters do indeed grow up with these outlets and they may lose meaning in their lives if they are removed from a “friend’s list.”

I loved when Betty White appeared on SNL (Saturday Night Live) and attributed it to a campaign on Facebook, which she, at 89, said she did not even know about, and then when she was exposed to it thought to herself, “what an incredible waste of time.”
Angst about one’s existence–a search for meaning of why we are “here,” has been discussed since the beginning of time. Erich Fromm used Adam and Eve as an allegory to discuss man’s search for meaning.

I wish I knew why I am here. Why was I offered an opportunity to blog on RenewEveryDay.com? Why am I able to make my living by helping others deal with their problems? Why am I a husband, a father, a friend to certain friends? Why am I an enemy to others? Why do I care? Why have I arrived at a place where I truly do believe in a higher power I call God?

Listen folks, if you think I have the answers, and that is why you read my blog, to quote Betty White, “What an incredible waste of time!”

I just attended my daughter's graduation at Bryn Mawr College—a woman's institution of higher education steeped in 125 years of tradition. The campus looks as if it were straight out of a "Harry Potter" set.

Kate Hepburn, class of '28, the only actor to win four Academy Awards, graduated from Bryn Mawr, along with Jacqueline Mars, class of '61, heiress to the Mars candy fortune, and other notable women such as Alice Rivlin, class of '52, the well-known economist.

I decided to write this week's blog on this topic because it was a wonderful occasion, but still, like so many things in life, it was bittersweet.

Here were all these young women going into a world of uncertainty—a world filled with wonder and anxiety. What better topic for a blog called "Angst?"

I thought to myself, as I approached graduation, that the past four years went by so quickly. My wife became misty-eyed as Alex received her diploma. It was a strange excitement to know that yet another milestone in this young woman's life had been reached.

Judith Jamison Addressed the Graduates
At the same time, what would this world of ours bring to this generation of women? Certainly, as Judith Jamison (such a spirit of dance and joy) noted in her speech to the Class of 2011, women have come a very long way. Yet I kept thinking that our world was so frightening—regardless of what gender one was.

Despite the name of my blog, I really am an optimist at heart, but you have to admit that the world is tricky today. Social and political unrest can be seen on our own shores, and then there is the world at large. I would have thought that by this time, in a world filled with so much religion, that it would be a more peaceful, loving place. Yet, by the time I was 5, we were at war in Viet Nam. There continues to be bloodshed and violence today, and I don't think it is unfair to say that it's often in the name of religion. How ironic!

Don't get me wrong. I believe everyone has a right to their own faith and I always have. I just wish those beliefs would lead to, well, to take a line out of the '60s, "... love not war."

In any case, putting war aside, these young women are facing a country with scant job prospects, the possibility that global warming may "melt" us all away, the very real possibility that Social Security will be "way gone" by the time they are ready to retire, bigger and "better" drugs, a real chance that people will only communicate via a "device," a scarcity of natural resources—which goes hand and glove with a continued population boom—and the list goes on, and on and on!

Well, that's perhaps the "bitter" side of things to come, but what about the "sweet"? There is the very real chance that science will lead to a cure for many life-threatening diseases, that technology could result in no need for oil or coal, that agriculture could lead to new food sources, that social scientists will continue to develop better

treatment outcomes for those with mental illness and addiction, that computer scientists will continue to develop forms of artificial intelligence that will produce new jobs instead of eliminating opportunities...here, too, the list goes on, and on and on!

I guess what we need to pray for, regardless of our religious practices, is for a future world where we discover that peace and productivity is the answer. Hey, I am starting to feel better already. Wow, peace and prosperity! Maybe this graduating class will be all right after all!

"When you look into an abyss, the abyss also looks into you." ~Friedrich Nietzsche

I wonder what emptiness does to make us act in ways both positive and negative! I know as a man, a husband, a father, a friend, a therapist, I am constantly starring into the "hole" or "whole" of life. I search for meaning in the tunnel of emptiness—a solitude of wonder that starts with a search for answers but often ends with a rationalization or answer that, wherever I end up, it is the will of my higher power.

I am a very blessed man. I have a wife who truly cares for me and a daughter who at times sees me as a hero (at least I think she does). I have people who pay to hear my voice—can you imagine?—and I must admit that makes me feel so blessed. I have several homes with grass and trees and flowers and water and a sense that when I journey "there" I arrive at a place that simply feels right.

The "abyss" is an empty, vacuous place that we often look into and at times it stares back at us and says: "I know where you live and the 'stuff' you have is meaningless unless you realize the love and caring embedded in it's essence."

Life once again, I realize, is a journey. It can be filled with joy, or it can be filled with sadness, perhaps due to the unwillingness to go on the expedition—the exploration of the "cosmos" that allows us to arrive at a destination of meaning and understanding.

I have met so many individuals on my journey. I have liked most and dismissed some, and I am sure—no, I know—that some have dismissed me. I always think to myself that those who do the dismissing don't take the time to get to know who I truly am—but I suppose that I sometimes don't pause long enough to do the same.

We are constantly looking for distractions on the journey instead of staying the course. There is so much falseness in this world of ours that I think we all have, one time or another, bought into it and thus the people we hate we indeed end up emulating. And vice versa. Man, what a complicated "cosmic" scene is life!

I am so sick of people rushing through everything they do. I have referred to this in past articles and interviews as a result of the “microwave generation.” I tell folks it will destroy—and has already started to destroy—our society.

Kids rush through their studies–not always learning but always hurrying so that they can get on to the next activity. This cracks me up because ultimately what are we rushing to? Death will come soon enough! Sorry to sound so pessimistic but in reality I am quite optimistic–if we live every moment as if it were our last.

“Living every moment as if we are our last” has become a cliché, of course, but remember that some phrases become overused for a reason: Because they make sense.

So what are we rushing to? Are we on the run to get as much done before we take that long dirt nap? Are we driving at speeds that allow us to rationalize to police officers that we were just “keeping up with traffic?” Are we rushing through meals because we have lost the sense that they are actually enjoyable opportunities to share glorious aspects of our day, or coming day, with people we love and enjoy? Are we rushing because we are frightened that if we are not as productive as possible we will not be able to pay our bills? Are we in a hurry to get to where we are going, because we might miss something? Do we have to multi-task because we just cannot fit it all in?
All I know is my angst is very high as a result of all this speed; this sense that no matter what I do, it is simply too slow!

I pray that perhaps we will catch up with ourselves and simply breathe and realize it is the journey that is most enjoyable. If, indeed, the “end justifies the means,” perhaps we need to pay more attention to the means. You see, even this end-goal philosophy supports the notion that the journey is what counts.

So here it is Easter. Indeed, coming from a family where my wife is Catholic and I am Jewish, there was never a question that the closest thing our daughter would have to religion would be Buddhism.

“The purpose of all the major religious traditions is not to construct big temples on the outside, but to create temples of goodness and compassion inside, in our hearts!” (Venerable Cheng Yen, date unknown).

In any case, this year we had Passover and Easter in the same week so family issues abounded. With large family gatherings comes joy and conflict–it is always hopeful that the joys outweigh the conflict and therefore we make great strides to stick a sock in it (our mouths that is).

In any case, Passover was at my dear cousin’s house and besides the stomach grumblings as we waited to get through the four questions and 10 plagues before a morsel of food could be consumed, I must say things came off without a hitch. As far as Easter Sunday, well let’s just say my angst was high. I was responsible for all the cooking (if you want a ham done just right, leave it to a Jewish boy!)

Easter at our home is always an occasion made up of family and friends who, in some cases, are closer than family. What is really interesting is that some of the folks that attend have been in recovery for many, many years while others have been into consuming as much alcohol as they can possibly imagine. Then there are those in the middle who perhaps have a glass of wine or two at most.

What We Talk About (What Don't We?)
This combination always makes for robust intellectual discussions that span politics, Zionism (yes I know it was Easter), the church’s position on abortion, recipes, whether or not Charlie Parker was as lyrical as Stan Getz, or vice versa, civil rights, Muslims, dead relatives, living relatives, friends who were not invited, baseball, higher education, taxes, art, the latest proposed cure for some disease, the legalization of marijuana, the New York Times bestseller list, technical advancements, the destruction of civil conversations because of technical advancements, jokes (both clean and dirty), the latest movies, television shows, the economy, the importance of sleep, sleep apnea, weight, diets, dieting, proper nutrition, juicing, high colonics, amazement at how many desserts were put out, water with or without fluoride, recycling…I could go on, but you get the idea.

The music flowed from CDs and the “Jonathan Schwartz Show” on radio; the fragrance of tulips and daffodils mixed with the rosemary from the potatoes was intoxicating. I must admit, despite my anxiety over menu planning, shopping, cooking and cleaning, these occasions are far better than texting or tweating or emailing or, dare I say it, “Skyping.” They are filled with the things that make this journey called life a real reason to celebrate and be grateful that we have been blessed to experience–well as my daughter would say–“the Zen of it.”

Yes, yes, I know an apple is a fruit and that would make it a food. But if you throw it at someone’s head is it now a weapon. Is it a weapon but still a food? Or does it take on what it is, given its context?

As a cognitively oriented psychologist, I find this interesting. You see, we are our consciousness—the conscious experience of what we perceive. Now the trick is understanding that our behavior is not simply mediated by the stimuli we encounter but by the way we think about the stimuli we encounter.

This is so important because we can change the way we think about our experiences. There are positive as well as negative ways to think about life, and our presence in life.

Think of the possibilities: The things that might create angst can be viewed in a different “light.” We can actually become optimists if we choose to see things in an affirmative way instead of with a jaundiced eye.

Look folks, all we have is the moment so why not stay in it and think about it in a manner that brings us peace? Dare I say even joy and happiness? If you simply put your mind to it, you can actually live a pretty happy life and, as the song says, “accentuate the positive.”

Yes, I know this sounds like a great deal of bother—all that thinking and rethinking. However, after some practice the rethinking will become automatic and thus not rethinking at all but pure, unadulterated original thought.

I have always owned a dog. Well I guess you really cannot "own" a dog—you take one into your family, if indeed you are a "dog person."

Currently, we have Gertrude. She is the sweetest English Bully one could ever imagine. A drooling, sleeping, eating, flatulent, snoring, bundle of bliss that gives this psychologist about the best therapy money can buy. She is quite generous with her time, so she comes to my office one Friday of every month and applies her therapeutic techniques with my patients as well.

Gertrude is a Rogerian by training. She specializes in the art of unconditional positive regard and folks soak up her nonjudgmental therapeutic stance with gusto. She is one of those therapists who does not say very much. She gives a knowing glance and sometimes is a tad boundary-invasive and will give a sloppy licky to an individual's face that at once says, "I accept you as you are. I am here for you. I may not know exactly what you are feeling, but I certainly appreciate your angst and I know what you had for lunch."

Gertrude really is what every therapist should be: Caring! Caring, you see, is theoretically why therapists should become therapists. I don't care if that means you care by holding patients responsible for their actions, or you care by allowing them to talk until insight blooms, or alter how they think through cognitive restructuring, or rearrange their environment so that they respond with healthy behaviors.

As the "father" of "Carefrontation"—a psychological stance that utilizes motivational enhancement and health-attribution locus of control (encouraging people to believe in themselves, help others and embrace spirituality)—I try every day to ascribe to Gertrude's techniques of therapeutic alliance. I attempt to motivate people without judging or enabling. I try to teach by sharing and not lecturing. I understand that anyone can feel psychologically unfit and desirous of medicating themselves with alcohol and other drugs. And, above all, I really try to forgive.

If you want to be a therapist, pray every day that the profession has gone to the dogs!

A dear friend took me to the opening game at Yankee Stadium last week. Man, it was exciting. He has box seats right at first base, about 12 rows back. As a lifelong Yankee fan, I literally died and went to heaven! Even though it was a cold day and lightly drizzling—well, perhaps a light sleet—we didn’t care. I mean, it was the Yankees and opening day. Great excitement overwhelmed the air.

Well, we were sitting there and about two rows in front of us, this man who had to be in his late thirties with a beer in his hand says to another guy, about 40 I would say, with a beer in each of his hands, “You’re in my seat.” The other guy responds with, “You’re out your f$#^king mind.”

You could feel the tension build as these two rather inebriated adults looked like they were about to square off. A number of filthy-language exchanges ensued—mind you with kids sitting all around watching. Finally, one of the first guy’s friends takes a closer look at the ticket and realizes that the man with a beer in each hand was in the correct seat. He tells his friend with the one beer in his hand that he is wrong, which results—now get this—with the two screaming fools embracing and the two-fisted beer drinker offering to buy everyone in the row from him down beers and shots. You can’t make this stuff up.

Now, here’s the kicker, I didn’t hear one person say to either dude, “Hey, watch your language.” But then again, many people around were drinking the largest beers (I mean this) I have ever seen! Fathers with children who, I assumed, they drove to the game were ordering beers left and right.

I don’t want to be a hypocrite so I will let you know I am not in recovery and, on a hot summer day, I have had a beer at a game. But that’s it, and only when I was not driving (when we left I saw many of these guys get behind the wheel in the parking lot), and certainly not with my daughter present when she was an underage kid. And that’s the truth. I don’t say this because I am better than anyone else, but because I think the game would be ruined for me with worry if I had. These guys seemed like they came to a drink-fest and a ballgame broke out. It just doesn’t make sense.

Why This Need To Create Angst?
Why can’t we simply enjoy life without creating angst? Here were a bunch of folks lucky enough to be sitting in seats others would die for but that wasn’t enough.

I always tell the youngsters I work with that before they start doing drugs they should smell the air, look at the sky and the water, enjoy tasting their food, dating, reading, watching a movie, playing a sport, hiking, camping, skiing, going out for band or a play, sailing, driving, or even flying a plane—enjoying what their minds can do before altering them. But with adults drinking at ballgames in front of their kids, you have to wonder why tweens or teens would not get the distinct message that alcohol and drugs are a necessary requirement to enjoy life.

This is not an article about alcoholism or addiction—about genetic predispositions, about the disease concept or compulsions, or whatever the latest research shows in my field. Nor is it an article on my judging others, especially when I certainly am no saint. It’s simply about all the things we take for granted that we could enjoy without mind-altering chemicals. Maybe my two beer-drinking friends would have still gotten into it sans beer. But could we just give life a chance? You know, on life’s terms?

I recently was interviewed on National Public Radio to discuss my thoughts on Charlie Sheen and America's obsession with what seems to be his wacky antics. I related that his "wacky antics" were a serious expression of either drug and alcohol intoxication, withdrawal, or perhaps a mood disorder, or all of the above. I have never treated Mr. Sheen, but I can certainly state as a psychologist who has specialized in addiction for decades, as well as mental illness and the combination of both, that he has not appeared to be in his right state of mind and has looked better!

"Why do we focus on Mr. Sheen when we have so many life-threatening issues occurring around the world?" I was asked. In particular, why have some news outlets

reported on Mr. Sheen prior to stories on Moammar Gadhafi (at thetime, the Japanese earthquake, tsunami, and nuclear disaster had not occurred). My answer was that Americans are more interested in
focusing on the safety of scandal then focusing on Middle East issues that result in potential massive loss of life, particularly in a post-9/11 world.

Human beings have always been drawn to circus sideshows prior to the "main attraction." The big-tent spectacle can result in the man on the flying trapeze actually falling to his death, while the oddity of the bearded lady or 600-pound man or tattooed lady are seemingly safe spectacles that are unusual but don't bring up our true fears of eros versus thanatos (life versus death).

But the irony in Mr. Sheen's case is he does indeed hit us where we live (or perhaps die). You see Mr. Sheen is ill—he is not a circus sideshow but a man who is destroyinghis life by what would appear to be addiction, or perhaps a mood disorder, or perhaps both. This should really be seen as the main attraction because, ironically, more people in this country die each year from these disease entities and their related medical sequelae than from most wars!

Addiction and mental illness are serious diseases and must be treated as such. By 2020, behavioral health disorders will surpass all physical diseases world-wide as a major cause of disability, according to the World Health Organization (WHO).

Like all diseases, they are primary, progressive, chronic and, if not treated, fatal. Yet, human beings are only too happy to stay in a state of denial and be entertained as some celebrities (what seems like America's appointed royalty) behave strangely from their brains being poisoned (or is "Celebrity Rehab" a figment of my imagination?)

So, I am filled with angst as I see our country tolerate families and friends slowly killing themselves instead of seeking treatment alternatives. I suppose treatment isn't as exciting as hotel rooms being destroyed or prostitutes being exploited, but trust me—if we don't start seeing these spectacles of despair as main attractions that could be anyone of us, and continue to treat them as freak shows, we, my friends, are doomed!

The phone rang late one night in the winter of 1992. I grabbed the receiver, fearing the worst. I knew the call must have something to do with my “godfather,” John Birks Gillepsie, who was dying of pancreatic cancer.

“Hey, man.”

It was reassuring to hear Dizzy’s voice, which rumbled like a storm front.

“Hey, Diz.”

“Whatcha up to?”

“Aaach. Trying to work on my dissertation. But I’m doing more staring than writing. It all seems like so much bullshit.”

“It’s hard to compose … ,” he said, leaving the thought hanging, as he often did, presuming I’d figure out the best way to finish it.

“What’s up, Diz?” I asked.

“C’mon over, man.”

“Yeah? It’s two o’clock in the morning. The hospital staff may get pissed off.”

“Nah, it’s only me and the nurse. C’mon over. I want you to hear something.”

Dizzy, among his many larger-than-life traits, was utterly compelling.

“Okay, man. What the hell, give me a half hour.”

“That’s cool.”

This Time Was Different
Within minutes, I was in my car. I always felt excited as I crossed the George Washington Bridge to visit Dizzy because I knew that he’d say something—or suggest we do something—that I could not have imagined. I always had the feeling that something cool was going to happen—even the simplest thing, like shooting a game of pool, which Dizzy turned into an exquisite ritual. This time was different. I was apprehensive. He wasn’t at home; he was in a hospital room. Part of Dizzy’s pancreas had been removed and his liver was not metabolizing his pain medication properly. Sometimes his mind was cloudy.

I arrived at Englewood Hospital and rode up the elevator. My heart started beating fast. Being there brought me back to the day he’d had his surgery a few weeks before, and how scared I was waiting for the surgeon to deliver the prognosis. As I walked into his room, Dizzy was sitting up in bed, listening to music through a headset perched on his broad face. His famous cheeks sagged from infirmity. He looked at me and smiled.

“Oh, yeahhhhhhh …,” he said.

It was a familiar, catchall phrase of Dizzy’s. I couldn’t tell if he remembered that he’d summoned me.

“Hey, man,” I said. “What are you listening to?”

“A-Night-In-Tune-Ease-Ya,” he said, his eyes twinkling like they did when he was on stage.

Night in Tunisia was Dizzy’s signature song. I loved the way he’d introduce it in concerts toward the end of his career.

“We are going to play a tune that has been closely associated with me for more than forty years,” he’d say. “As a matter of fact, I wrote it.”

The audience would laugh politely.

“This par-tic-u-lar tune has withstood the vi-ciss-i-tudes of the con-tin-gent world,” he'd continue, standing back from the microphone with the smirk of a boy who has just aced the Spelling Bee, “and has MOSEYED” — he’d cock his head and suspend his thumbs upward as if he were snapping invisible suspenders —”into the realm of the meta-phys-i-cal.”

The hoots and hollers would steamroll into applause as Dizzy preened in the spotlight. Then came the kicker.

“Damn good for a South Carolina high school dropout, wasn’t it,” he’d say.

The Notes He Didn't Play
I looked at Dizzy with wide eyes.

“Man, you wrote that song. You’ve played that song probably hundreds of thousands of times,” I joshed, “and that’s what you’re listening to? A Night in Tunisia?”

“Well,” he replied, “I’m listening to the notes I didn’t play.”

“Diz, c’mon man, cheer up,” I blurted, feeling broken hearted. I had my therapist’s hat on. Dizzy was always the one making everybody else feel good, but here was this great man at the end stage of his life caught up in Erik Erikson’s concept of ego integrity versus despair. He seemed unable to appreciate one of his great accomplishments as the triumphant work of art that it was.

“You wrote a wonderful song,” I continued in a soothing voice. “You built a wonderful life. Why are you so remorseful?”

“Oh, mannnnnnnnnnnnnnnnnnn,” he replied, shaking his head slowly. It was a groan that seemed to come from the pit of his being. I’d heard it throughout the nearly forty years that Dizzy had been a major presence my life. “Didn’t I teach you anything?”

I stared back into his eyes, ready to absorb.

“No, man. I’m not listening to the notes I didn’t play because I’m bummed out,” he said, enunciating each word precisely. “I’m listening to the notes I didn’t play because they make the notes I chose to play that much sweeter.”

Dizzy reinforced a lesson that morning that he’d taught me many times before. As we improvise on the score that is our lives with every breath we take, the choices we don’t make are just as important as the ones we do. Dizzy’s overriding principle was that we should make our decisions based on one standard: What’s right? What’s decent? How would I like to be treated under similar circumstances?

It’s not that Dizzy didn’t suffer from angst like the rest of us. He certainly did. But when you hit the wrong note, as you certainly will from time to time, you’ve got to learn to leave it behind you.

Don’t you love anguish, torment, worry, anxiety, sorrow, and plain old fear? That wonderful sense that your world is collapsing and the only thing that will help is Scotch neat, or a “j” filled with fragrant, freshly rolled sensimilla, or perhaps some “h” or “coke.”

Only problem is that sooner or later they wear off and the misery returns. Hemingway, Joplin, Dylan Thomas, Miles Davis, Pollack, Hunter Thompson, Getz, Faulkner, Clapton, etc., all discovered at some point that the pain returns. Even if in some cases the substance takes you out, the journey back to reality bites. Oh yeah, and then there is the addiction angle!

Look folks, life really can suck at times or perhaps our thoughts make it seem that way. Hey, maybe thoughts can be changed? (Now there’s a thought.)

So why have I decided to write a blog and call it “Angst”? Because at least it is an affirmation of life.

This will be a weekly stroll about all those things that give us pain–the pain we hate, the pain we love, the senseless crap that makes us feel, and hate, and cry and even, ironically, laugh. It’s about the torment that causes us to kick up a genetically predisposed addiction that spirals our life down a mudslide of refuse.